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Zhang Q, Gu X, Liu S, Fu R, Wang Y, Hegarty J, Zhu P, Ge J. Decisional Conflicts in Patients With Low-Risk Papillary Thyroid Microcarcinomas Considering Active Surveillance. JAMA Otolaryngol Head Neck Surg 2024:2823475. [PMID: 39298152 PMCID: PMC11413754 DOI: 10.1001/jamaoto.2024.2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/07/2024] [Indexed: 09/25/2024]
Abstract
Importance Internationally, active surveillance has been shown to be beneficial and safe in the management of low-risk papillary thyroid microcarcinomas. However, choosing active surveillance is a difficult treatment decision for patients with low-risk papillary thyroid microcarcinomas. Objective To identify and analyze the antecedents and mediating processes of decisional conflicts when patients consider active surveillance as an alternative to surgery. Design, Setting, and Participants In this qualitative study, semistructured interviews were conducted between April 2023 and December 2023 at 3 tertiary hospitals in China. Thirty-one participants who were diagnosed with low-risk papillary thyroid microcarcinomas, who had experienced considering active surveillance as an alternative to surgery and who scored above 25 on the decision conflict scale were purposively recruited. Inductive content analysis led to emergent themes. Data analysis was performed from April 2023 to February 2024. Methods used to protect the trustworthiness of the study results included audit trails and member checks. Main outcomes and Measures Patients' experience of decisional conflicts and the antecedents and mediating processes relating to these decisional conflicts. Results Among 31 participants (median [range] age, 39.2 [22-63] years; 22 [71%] were female and 9 [29%] were male), 3 themes were classified: (1) decisional conflicts in decision preparation, (2) decisional conflicts in decision-making, and (3) decisional conflicts in decision implementation. The patient's experiences of decisional conflicts were diverse and occurred throughout the entire decision-making process. The antecedents of the decisional conflicts included personal influencing factors, system-level influencing factors, and the relational-situational context. Patients with low-risk papillary thyroid microcarcinomas interacted with these antecedents in the process of decision-making and eventually failed to mediate, leading to decisional conflicts. Conclusions and relevance This qualitative study found that patients with low-risk papillary thyroid microcarcinomas experienced clinically significant decisional conflicts and experienced considerable challenges and psychological problems in decision-making. The antecedents of decisional conflicts and accompanying mediating processes can provide guidance for individuals, health care professionals, and health care systems to provide decision support for patients with low-risk papillary thyroid microcarcinomas.
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Affiliation(s)
- Qianqian Zhang
- Department of Anesthesia and Perioperative Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Xinyue Gu
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Shuangyuan Liu
- Department of Anesthesia and Perioperative Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Rong Fu
- Department of General Surgery, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Ying Wang
- Department of General Surgery, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Josephine Hegarty
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Pingting Zhu
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Jiangsu Key Laboratory of Zoonosis, Yangzhou, Jiangsu, People’s Republic of China
| | - Jingwu Ge
- Department of Anesthesia and Perioperative Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
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Lin X, Qulian G, Bai Y, Liu Q. Differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care: a cross-sectional investigation in pediatric settings in China. BMC Nurs 2024; 23:386. [PMID: 38844953 PMCID: PMC11155171 DOI: 10.1186/s12912-024-02052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/30/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Countries abroad have implemented pediatric palliative treatment for several years; however, complete pediatric palliative treatment guidelines and legal guidance remain lacking in China, making the implementation of palliative care difficult. PURPOSE This study aimed to understand the current situation, similarities, and differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care for children. METHODS This cross-correlation study collected data from pediatric and neonatal intensive care units of four hospitals in China. The participants comprised 180 caregivers and 172 healthcare providers. The measurement tools included the palliative care knowledge scale, palliative care attitude scale, and pediatric palliative care needs scale. This study adhered to the STROBE reporting guidelines. RESULTS Significant differences in palliative care knowledge, attitudes, and needs were observed between caregivers and healthcare providers (p < 0.005). Pediatric healthcare providers demonstrated higher knowledge and positive attitudes regarding palliative care than caregivers. Needs for communication in general and relief from pain and other symptoms of caregivers were higher than those of healthcare providers (p < 0.001). Furthermore, palliative care attitude and needs of healthcare providers were positively correlated with each other (r = 0.212, p < 0.005). CONCLUSION Pediatric healthcare providers and caregivers demonstrated different perceptions of needs for palliative care. The results of this study can serve as a reference for the future development of guidelines related to children's needs and related interventions.
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Affiliation(s)
- Xi Lin
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, P. R. China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, 646000, Sichuan, P. R. China
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Guo Qulian
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, P. R. China
- Sichuan Clinical Research Center for Birth Defects, Luzhou, 646000, Sichuan, P. R. China
| | - Yongqi Bai
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, P. R. China.
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Qin Liu
- Department of Pediatrics, Children Hematological Oncology and Birth Defects Laboratory, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, P. R. China.
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Koot A, Hermens R, Ottevanger P, Netea-Maier R, Stalmeier P. Patient decision aids for patients with differentiated thyroid carcinoma: development process and alpha and beta testing. Front Endocrinol (Lausanne) 2023; 14:1162537. [PMID: 37324263 PMCID: PMC10264809 DOI: 10.3389/fendo.2023.1162537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Patient decision aids (PtDAs) are structured clinical tools that facilitate shared decision-making. Two important treatment decisions for patients with differentiated thyroid cancer (DTC), which could benefit from PtDAs, are as follows (1): the extent of surgery decision in patients with low-risk DTC and (2) the decision to start or delay starting the treatment with tyrosine kinase inhibitors (TKIs) in patients with advanced tumors. Material and methods PtDAs for these two decisions were developed using the International Patient Decision Aids Standards (IPDAS) quality criteria in an iterative process of prototype development via alpha and beta testing by patients and physicians. The information content of the PtDAs was based on the available literature, current guidelines, and patient's needs, preferences, and values. Results The web-based PtDAs underwent two rounds of alpha testing, revisions, and beta testing. The PtDAs have the same structure, consisting of six steps: a general introduction, information about the treatment options, comparing the treatment options, knowledge questions, a values clarification exercise, and saving the information. The alpha testing (n = 8 patients, n = 10 physicians) showed that the PtDAs were highly acceptable and usable for decision-making. Results of the beta testing in 20 patients showed that two patients did not use the PtDA; the other 18 patients found that the PtDAs were readable (n = 17) and helpful (n = 14) for decision-making. All patients recommend using the PtDAs. Conclusions Evidence-based PtDAs were created for patients with DTC for two different treatment decisions. Our final version was judged to be clear, balanced, and helpful in decision-making.
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Affiliation(s)
- Anna Koot
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella Hermens
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, Netherlands
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
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Yang W, Lee YK, Lorgelly P, Rogers SN, Kim D. Challenges of Shared Decision-making by Clinicians and Patients With Low-risk Differentiated Thyroid Cancer: A Systematic Review and Meta-Ethnography. JAMA Otolaryngol Head Neck Surg 2023; 149:452-459. [PMID: 36951823 DOI: 10.1001/jamaoto.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Importance Several international guidelines have endorsed more conservative treatment of low-risk differentiated thyroid cancer (LRDTC), yet patients are facing more treatment options with similar oncologic outcomes and are expressing feelings of confusion, dissatisfaction, and anxiety. Shared decision-making, which considers the patient's values and preferences along with the most reliable medical evidence, has been proposed to optimize patient satisfaction in the context of the current clinical equipoise. Objectives To understand key individual and behavioral factors affecting the patient and clinician decision-making process in treatment decision for LRDTC. Evidence Review This systematic review and meta-ethnography involved a comprehensive literature search of MEDLINE, Embase, PubMed, and CINAHL databases for qualitative and mixed-method studies on patient and clinician experiences with the decision-making process for LRDTC treatment. The quality of the studies was assessed using the Mixed Methods Appraisal Tool; meta-ethnography was used for data analysis. Primary and secondary themes of the included studies were extracted, compared, and translated across articles to produce a lines-of-argument synthesis. Findings Of 1081 publications identified, 12 articles met the inclusion criteria. The qualitative synthesis produced 4 themes: (1) a bimodal distribution of patient preferences for treatment decisions; (2) clinician anxiety affected equipoise and biased their recommendations; (3) clinicians struggled to identify patient concerns and preferences; and (4) the clinician-patient relationship and psychosocial support were key to shared decision-making but were frequently overlooked. Conclusions and Relevance The findings of this systematic review and meta-ethnography emphasize the need for better patient-clinician communication, particularly with respect to eliciting patient concerns and preferences. With an ever-increasing pool of thyroid cancer survivors, future efforts should be directed at establishing and evaluating tools that will aid in shared decision-making for treatment of patients with LRDTC. Trial Registration PROSPERO Identifier: CRD42022286395.
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Affiliation(s)
- Wanding Yang
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Ying Ki Lee
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
| | - Paula Lorgelly
- Faculty of Medical and Health Sciences and School of Business, University of Auckland, Auckland, New Zealand
| | - Simon N Rogers
- Department of Oral and Maxillofacial Surgery, Wirral University Teaching Hospital, Birkenhead, UK
- Faculty of Health, Social Care and Medicine, Edge Hill University, Liverpool, UK
| | - Dae Kim
- Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
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Ronchi CL, Altieri B. Special Issue: Present and Future of Personalised Medicine for Endocrine Cancers. J Pers Med 2022; 12:710. [PMID: 35629133 PMCID: PMC9145565 DOI: 10.3390/jpm12050710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Major technological advances in genomics have made it possible to identify critical genetic alterations in cancer, rendering oncology well along the path to personalised cancer medicine [...].
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Affiliation(s)
- Cristina L. Ronchi
- Institute of Metabolism and System Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Endocrinology, Diabetes, and Metabolism (CEDAM), Birmingham Health Partners, Birmingham B15 2TT, UK
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, 97080 Wuerzburg, Germany;
| | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, 97080 Wuerzburg, Germany;
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