Negative emotions substantially influence treatment decisions for low-risk thyroid cancer
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Among adults receiving treatment for low-risk thyroid cancer, negative emotions may play an important role in decision-making, according to qualitative study results published in Thyroid.
“When diagnosed with low-risk thyroid cancer, patients must weigh the benefits, harms and risks of treatment alternatives, consider their goals and preferences and choose a treatment option that is right for them. This decision is complex and not solely based on cognitive processing of risk,” Susan C. Pitt, MD, MPHS, an endocrine surgeon at the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues wrote. “Theories of decision-making demonstrate that emotions heavily influence choice and can bias perceptions of risk leading to decisions that do not align with one’s preferences and values.”
Researchers recorded treatment conversations regarding clinically low-risk thyroid cancer or biopsy suspicious for thyroid cancer between 30 patients (median age, 48.5 years; 80% women) and nine surgeons (median years in practice, 7 years; 66.7% men). Patients and surgeons were from two diverse, academic U.S. hospitals. Emotional content was taken verbatim from transcripts and characterized through inductive and deductive content analyses.
The primary focus of patients’ expressions of emotion focused on their diagnosis and treatment outcomes, and most were negative emotions, including fear and anxiety about cancer and the cancer growing or spreading. In response to such negative emotions, most surgeons used education to reassure their patients, often highlighting low probabilities of adverse events, rather than empathy or validation. Many surgeons emphasized the “slow-growing” nature of thyroid cancer as well as the excellent prognosis of this specific cancer compared with others.
When discussing treatment, researchers noted that surgeons often described alternatives in terms of emotional outcomes; for example, surgeons would say that total thyroidectomy would result in “peace of mind” or a “sense of completeness,” whereas a lobectomy or active surveillance might result in “worry” or “bother” about cancerous tissue remaining.
In addition, surgeons reassured patients that there are “two right answers” and “no rush” for deciding on treatment.
According to the researchers, these emotional findings appear to support decisions that may potentially overtreat low-risk thyroid cancer and represent a barrier to lobectomy or active surveillance.
“These findings are critically important because better emotional support at the time of diagnosis and during treatment decision-making have the potential to decrease unnecessarily extensive surgery and promote active surveillance for appropriate patients,” the researchers wrote. “Interventions that provide peace of mind without thyroidectomy by increasing the ability of patients to cope with their diagnosis have the potential to reduce overtreatment and promote active surveillance for low-risk thyroid cancer.”
Perspective
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The majority of patients with differentiated thyroid cancer have low-risk disease and favorable prognosis. However, despite the most recent American Thyroid Association guideline supporting consideration of less intensive management in these patients, such as active surveillance or lobectomy, most continue to undergo total thyroidectomy in the United States despite higher morbidity. In this qualitative study, Pitt and colleagues found that both physicians’ and patients’ negative emotions toward thyroid cancer diagnosis and treatment outcomes often drive treatment decisions toward more intensive management and thus potential overtreatment. For example, peace of mind after total thyroidectomy was important for both surgeons and their patients, despite patients’ having excellent prognosis.
This study highlights an important, clinically relevant but complex topic — the impact of emotions on treatment intensity for patients with low-risk thyroid cancer. Findings from this study underscore the need for improving unbiased conversations between physicians and patients to, first, ensure patient comprehension of risks and benefits of each treatment option empowering them to partake in shared decision-making and, second, increasing physicians’ recognition of and adequately addressing patient concerns, while being mindful of their own biases and how these can guide treatment decisions. Efforts to adequately address experienced and anticipated emotions in patients with a recent diagnosis of low-risk thyroid cancer and their physicians can help increase uptake of less intensive management options and reduce patient harm.
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