Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study
Objective Patient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associa...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-06-01
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| Series: | OTO Open |
| Online Access: | https://doi.org/10.1177/2473974X211015937 |
| _version_ | 1827610318333804544 |
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| author | Victoria Kuta MD David Forner MD, MSc Jason Azzi MD Dennis Curry MD, MSc Christopher W. Noel MD Kelti Munroe MD Martin Bullock MD, FRCSC Ted McDonald PhD S. Mark Taylor MD, FRCSC Matthew H. Rigby MD, MPH, FRCSC Jonathan Trites MD, FRCSC Stephanie Johnson-Obaseki MD, MPH, FRCSC Martin J. Corsten MD, FRCSC |
| author_facet | Victoria Kuta MD David Forner MD, MSc Jason Azzi MD Dennis Curry MD, MSc Christopher W. Noel MD Kelti Munroe MD Martin Bullock MD, FRCSC Ted McDonald PhD S. Mark Taylor MD, FRCSC Matthew H. Rigby MD, MPH, FRCSC Jonathan Trites MD, FRCSC Stephanie Johnson-Obaseki MD, MPH, FRCSC Martin J. Corsten MD, FRCSC |
| author_sort | Victoria Kuta MD |
| collection | DOAJ |
| description | Objective Patient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population. Study Design This is a retrospective cross-sectional study of patients with Bethesda III and IV thyroid nodules. Setting Multi-institutional. Methods Factors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients. Results A total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%-83%; P ≤.0001). Fee-for-service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263-2.175; P < .001) and community hospital settings (OR, 1.529; 95% CI, 1.145-2.042; P < .001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery. Conclusion While it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient-centered shared decision making. |
| first_indexed | 2024-03-09T07:47:46Z |
| format | Article |
| id | doaj.art-461bdbc0b2fe401898fd0700fb9a42fe |
| institution | Directory Open Access Journal |
| issn | 2473-974X |
| language | English |
| last_indexed | 2024-03-09T07:47:46Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | OTO Open |
| spelling | doaj.art-461bdbc0b2fe401898fd0700fb9a42fe2023-12-03T02:43:02ZengWileyOTO Open2473-974X2021-06-01510.1177/2473974X211015937Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional StudyVictoria Kuta MD0David Forner MD, MSc1Jason Azzi MD2Dennis Curry MD, MSc3Christopher W. Noel MD4Kelti Munroe MD5Martin Bullock MD, FRCSC6Ted McDonald PhD7S. Mark Taylor MD, FRCSC8Matthew H. Rigby MD, MPH, FRCSC9Jonathan Trites MD, FRCSC10Stephanie Johnson-Obaseki MD, MPH, FRCSC11Martin J. Corsten MD, FRCSC12Division of Otolaryngology–Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, CanadaDivision of Otolaryngology–Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, CanadaFaculty of Medicine, University of Ottawa, Ottawa, CanadaFaculty of Medicine, Dalhousie University, Halifax, CanadaDepartment of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, CanadaFaculty of Medicine, Dalhousie University, Halifax, CanadaDepartment of Pathology, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, CanadaDepartment of Economics, University of New Brunswick, Fredericton, New Brunswick, CanadaDivision of Otolaryngology–Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, CanadaDivision of Otolaryngology–Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, CanadaDivision of Otolaryngology–Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, CanadaDepartment of Otolaryngology–Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, CanadaDivision of Otolaryngology–Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, CanadaObjective Patient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population. Study Design This is a retrospective cross-sectional study of patients with Bethesda III and IV thyroid nodules. Setting Multi-institutional. Methods Factors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients. Results A total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%-83%; P ≤.0001). Fee-for-service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263-2.175; P < .001) and community hospital settings (OR, 1.529; 95% CI, 1.145-2.042; P < .001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery. Conclusion While it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient-centered shared decision making.https://doi.org/10.1177/2473974X211015937 |
| spellingShingle | Victoria Kuta MD David Forner MD, MSc Jason Azzi MD Dennis Curry MD, MSc Christopher W. Noel MD Kelti Munroe MD Martin Bullock MD, FRCSC Ted McDonald PhD S. Mark Taylor MD, FRCSC Matthew H. Rigby MD, MPH, FRCSC Jonathan Trites MD, FRCSC Stephanie Johnson-Obaseki MD, MPH, FRCSC Martin J. Corsten MD, FRCSC Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study OTO Open |
| title | Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study |
| title_full | Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study |
| title_fullStr | Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study |
| title_full_unstemmed | Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study |
| title_short | Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study |
| title_sort | treatment choices in managing bethesda iii and iv thyroid nodules a canadian multi institutional study |
| url | https://doi.org/10.1177/2473974X211015937 |
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