Read this paper before signing up for a thyroidectomy.
1. Patients commonly expressed negative emotions like fear and anxiety about “the C-word” and worried about the cancer growing or spreading.
2. Many surgeons in my experience use fear tactics to get thyroid patients to have surgery.
3.Surgeons in my opinion recommend total thyroidectomy as providing “peace of mind” or a “sense of completeness.
4. Surgeons warn that cancer or thyroid tissue remaining in the body with active surveillance or lobectomy might “worry” or “bother” patients.
5. Even thyroid surgeons in my opinion tend to rush the patient to surgery even without a second opinion.
6. Surgeons give lip service to any approach other than surgery in most of their cases.
7. Patients express negative emotions during treatment decision-making interviews by surgeons. These emotions are increased by the way the surgeon expresses the urgent need for early surgery without second opinions.
8. Surgeons and patients both acknowledge patient fear and anxiety as a reason they choose thyroidectomy instead of active surveillance or radiofrequency ablation. That fear is fostered my the surgeon’s own presentation.
9. Peace of mind gained by patients as a result of thyroidectomy may lead to overtreatment of patients with low-risk thyroid cancer. There are serious complications with a thyroid surgery.
10. Discussion of the risks and need for a thyroidectomy has been poorly handled by surgeons.
11. Rarely do they mention active surveillane and almost never the use of radiofrequency ablation ThyroidRFA.
12. Thyroid RFA has been shown to ablate the small cancer just as the surgery, but leaves the rest of the thyroid intact, with no scar, no lifetime thyroid hormone therapy.
13. In my opinion thyroid RFA will become the treatment of choice among patients who do not want surgeons pushing thyroidectomies, or long term active surveillance follow up with the cancer in their necks.
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ThyroidVol. 31, No. 12 Thyroid Cancer and Nodules
Susan C. Pitt, Megan C. Saucke, Benjamin R. Roman, Stewart C. Alexander, and Corrine I. VoilsPublished Online:16 Dec 2021https://doi.org/10.1089/thy.2021.0323V
Background: Little is known about the role of emotions in treatment decisions for thyroid cancer. We aimed to characterize the emotional content of patient–surgeon communication during decision-making about low-risk thyroid cancer treatment.
Methods: We audio-recorded conversations about treatment for clinically low-risk thyroid cancer or biopsy suspicious for thyroid cancer between patients (n = 30) and surgeons (n = 9) in two diverse, academic hospitals in the United States. Inductive and deductive content analyses were used to characterize the emotional content in verbatim transcripts.
Results: Patients’ expression of emotion focused on primarily on their diagnosis and treatment outcomes. Patients commonly expressed negative emotions like fear and anxiety about “the C-word” and worried about the cancer growing or spreading. In response, most surgeons used education, as opposed to empathy or validation, to reassure patients, often highlighting low probabilities of adverse events. Surgeons emphasized the “slow-growing” nature and excellent prognosis of thyroid cancer compared with other malignancies. When discussing treatment options, surgeons often described alternatives in terms of their emotional outcomes. Some described total thyroidectomy as providing “peace of mind” or a “sense of completeness,” warning that cancer or thyroid tissue remaining in the body with active surveillance or lobectomy might “worry” or “bother” patients. Surgeons supported deliberation by reassuring patients that there are “two right answers” and “no rush” to decide.
Conclusions: Patients express negative emotions during treatment decision-making. In response, surgeons often miss opportunities to provide empathy in addition to education. Surgeons and patients both acknowledge patient fear and anxiety as a reason to choose thyroidectomy instead of active surveillance. Peace of mind gained by patients and surgeons as a result of thyroidectomy may lead to overtreatment of patients with low-risk thyroid cancer.
To cite this article:Susan C. Pitt, Megan C. Saucke, Benjamin R. Roman, Stewart C. Alexander, and Corrine I. Voils.Thyroid.Dec 2021.1800-1807.http://doi.org/10.1089/thy.2021.0323Published in Volume: 31 Issue 12: December 16, 2021