Exploring Perspectives and Preferences for Over-Diagnosis and Overtreatment of Thyroid Nodules using a MCDA Method

Abstract

Background: The detection of thyroid cancer has rapidly increased over last few decades without an increase in disease specific mortality. Several studies claim that the diagnose of thyroid nodules through routine ultrasound imaging is often the trigger for cascade effects leading to unnecessary follow-up over many years or to invasive treatment. The objective of this study was to explore physicians’ and patients’ insights and preferences for diagnosis and treatment of thyroid nodules as well as awareness of over-diagnosis and overtreatment. Methods: An online survey was developed using a comprehensive multi criteria decision Analysis (MCDA) framework, the EVIdence based Decision-Making (EVIDEM). The EVIDEM core model used in this study encompassed 13 quantitative criteria and four qualitative criteria. Participants were asked to provide weights for each criterion, performance scores for appraising the thyroid nodules interventions and their consideration of impact of contextual criteria. Normalized weights and standardized scores were combined to calculate a value contribution across all participants, additionally differences across participants were explored. Results: Of all 105 participants, there are 48 patients, 31 physicians and 26 normal citizens. The highest value estimate of the intervention on thyroid nodules reached 0.401 for citizens’ group and lowest value of 0.287 was reported for physicians’ group, compared to 0.359 for all participants. The highest value contributors were efficacy and prevention. Compared to all participants, physicians gave less weight to quality of life and prevention benefits. In addition, physicians’ group gave less score on the treatment such like thyroid surgery compared to other two groups. 59% participants considered healthcare system had a positive impact on the diagnostic of thyroid nodules. Conclusion: Our study shows participants’ preferences on each criterion, i.e., physician indicated keeping the intervention safe and effective more important, patients indicated quality of life after receiving intervention more important. Through comparison among participants, differences have been highlighted, which can make better communication between physicians and patients. This study provided a supportive decision making for health providers when they conduct researches on thyroid nodules.Trial registration: This study did not report the results of a health care intervention on human participants.