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01-06-2017 | Original Scientific Report

Determining Patient Preferences for Indeterminate Thyroid Nodules: Observation, Surgery or Molecular Tests

Authors: Daniel Joonil Lee, Jason J. Xu, Dale H. Brown, Ralph W. Gilbert, Patrick J. Gullane, Jonathan C. Irish, Lorne E. Rotstein, David P. Goldstein, John R. de Almeida

Published in: World Journal of Surgery | Issue 6/2017

Abstract

Background

Gene-expression classifiers (GEC) and genetic mutation panels (GMP) have been shown to improve preoperative diagnostic evaluations of indeterminate thyroid nodules. Despite the improvement, uncertainty regarding the proper management exists. Patient preferences may better inform the management of these indeterminate thyroid nodules.

Methods

Hypothetical scenarios were administered to two groups of patients: those with previous FNA-confirmed indeterminate thyroid nodules (Group A, n = 50) and those presenting to a general otolaryngology clinic for other reasons (Group B, n = 50). We evaluated patient preferences for surgery, observation and the use of molecular tests while varying the risk of malignancy, cost and diagnostic properties of the tests.

Results

The mean threshold for choosing surgery over observation was a 38.6% risk of malignancy on FNA. When offered either GEC, GMP or both (with their inherent imperfect diagnostic properties) in addition to the indeterminate FNA, 85.0% of respondents picked at least one of the molecular tests over either observation or surgery if the test(s) were free of charge. However, only 51.7% of respondents chose at least one of the tests when asked to pay the current cost of the test(s) (p < 0.001). On multivariable analysis, sex, the presence of an indeterminate FNA diagnosis and income level significantly predicted the desire to proceed with a molecular test above standard management.

Conclusion

Patient preferences for thyroid nodule management are dependent on the risk of malignancy, prognosis of cancer and costs. Patients prefer molecular tests over standard management with indeterminate thyroid nodules, but the costs of the test(s) reduce the desire.

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Title: Determining Patient Preferences for Indeterminate Thyroid Nodules: Observation, Surgery or Molecular Tests
Authors: Daniel Joonil Lee
Jason J. Xu
Dale H. Brown
Ralph W. Gilbert
Patrick J. Gullane
Jonathan C. Irish
Lorne E. Rotstein
David P. Goldstein
John R. de Almeida
Publication date: 01-06-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 6/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3887-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Determining Patient Preferences for Indeterminate Thyroid Nodules: Observation, Surgery or Molecular Tests

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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