Peace of Mind: A Role in Unnecessary Care?

Abstract

Consider this excerpt from a real patient-surgeon conversation about treatment for a small, early-stage thyroid cancer and deliberating three equivalent treatment options: active surveillance, hemithyroidectomy, and total thyroidectomy. Patient: What do you recommend on my case? Surgeon: I could probably argue any of the three. I think, what I'm hearing from you is that peace of mind is important… Patient: Yes. Surgeon: If we're going to go down the surgery path, I would probably recommend a total. Patient: Mmm hmm.Surgeon: Knowing that it will definitively get the entire thyroid out so hopefully should give us peace of mind.Author affiliations and support information (if applicable) appear at the end of this article.

Physician Perspectives of Overdiagnosis and Overtreatment of Low-Risk Papillary Thyroid Cancer in the US

“…Need for diagnostic certainty and fear of missing a diagnosis have been associated with overdiagnosis and overtreatment in other contexts. 4,5 Although our study may be limited by nonresponse bias, we found no differences between early and late respondents and between respondents and nonrespondents. Our study did not include primary care physicians, who may also influence the decision to pursue thyroid nodule biopsy.…”

“…Physicians favoring overdiagnosis also indicated that peace of mind from more extensive surgery influenced their recommendations. Need for diagnostic certainty and fear of missing a diagnosis have been associated with overdiagnosis and overtreatment in other contexts . Although our study may be limited by nonresponse bias, we found no differences between early and late respondents and between respondents and nonrespondents.…”

Medical Maximizing Preferences and Beliefs About Cancer Among US Adults

“…9,10 Management of cancer is particularly susceptible to medical overuse and unnecessary care and occurs at multiple time points, including screening, diagnosis, treatment, and surveillance. 7,11,12 The emphasis on shared decision-making, individualized care at each phase along the cancer care continuum, and the expansion of potential treatment modalities with their own unique benefits and risks has increased the importance of incorporating patient preference into oncologic medical decision-making. Further challenging the decision-making process is that the diagnosis or potential diagnosis of cancer has a major emotional effect on patients that can influence their preference and color their decision-making.…”

“…Countless examples in the literature document frequent use of unneeded diagnostic tests, medical treatments, and invasive interventions that provide no proven clinical benefit . Although the cause of overtreatment is multifactorial and includes physician- and system-level factors—such as fear of malpractice, lack of care coordination, duplicate tests, and diminished time with patients—patient preference has also been cited as a major contributor to overtreatment, yet is less often studied . In a survey of more than 2000 physicians, the second most commonly cited reason for overtreatment, after fear of malpractice, was pressure from patients to order tests and treatments .…”

“… 2 , 3 , 4 Although the cause of overtreatment is multifactorial and includes physician- and system-level factors—such as fear of malpractice, lack of care coordination, duplicate tests, and diminished time with patients—patient preference has also been cited as a major contributor to overtreatment, yet is less often studied. 5 , 6 , 7 In a survey of more than 2000 physicians, the second most commonly cited reason for overtreatment, after fear of malpractice, was pressure from patients to order tests and treatments. 8 Part of this push from patients comes from a common perception that more care means better care, combined with increased satisfaction when patients perceive something proactive is “being done” for their health, regardless of utility.…”