Preferences of patients and clinicians for treatment of Graves’ disease: a discrete choice experiment

Abstract

Objective: Treatment options for Graves’ disease (GD) consist of antithyroid drugs (ATD), radioactive iodine (RAI) and total thyroidectomy (TT). Guidelines recommend to discuss these options with patients, taking into account patients’ preferences. This study aims to evaluate and compare patients’ and clinicians’ preferences and the trade-offs made in choosing treatment. Design and methods: A discrete choice experiment (DCE) was performed with GD patients with a first diagnosis or recurrence in the previous year, and with clinicians. Participants were offered hypothetical treatment options which differed in type of treatment, rates of remission, severe side effects, permanent voice changes and hypocalcemia. Preference heterogeneity was assessed by latent-class analysis. Results: 286 (82%) patients and 61 (18%) clinicians participated in the DCE. All treatment characteristics had a significant effect on treatment choice (p<0.05). Remission rate was the most important determinant and explained 37% and 35% of choices in patients and clinicians, respectively. Both patients and clinicians preferred ATD over surgery and RAI. A strong negative preference towards RAI treatment was observed in a subclass of patients, whereas clinicians preferred RAI over surgery. Conclusion: In both patients and clinicians, remission rate was the most important determinant of treatment choice and ATD was the most preferred treatment option. Patients had a negative preference towards RAI compared to alternatives, whereas clinicians preferred RAI over surgery. Clinicians should be aware that their personal attitude towards RAI differs from their patients. This study on patients’ and clinicians’ preferences can support shared decision making and thereby improve clinical treatment.

Methimazole Desensitization in a Patient Experiencing a Thionamide-induced Hypersensitivity Reaction

“…In practice, around half of patients treated with 12 to 18 months of ATD therapy will achieve remission, with remission defined as euthyroidism 3 to 6 months after the last administered dose of ATD. Most of these patients will remain euthyroid once normal thyroid indices are achieved ( 9 , 10 ). Current guidelines suggest that treatment approach in hyperthyroidism should be individualized and part of a shared decision-making process with each patient.…”

Patient Experiences With Thyroid Nodules: A Qualitative Interview Survey

“…21 , 22 , 23 These techniques have previously been used in otolaryngology and thyroid surgery. 17 , 24 , 25 , 26 , 27 , 28 Studies have demonstrated that antithyroid drugs for Graves disease were generally preferred by patients over surgery or radioactive iodine, 29 that significant cosmetic considerations regarding thyroid surgery should be factored into decision‐making, 30 and that risk of needing a subsequent contralateral hemithyroidectomy for those undergoing unilateral procedures is a significant driver of decision‐making. 31 (Although the topic of hemithyroidectomy was not explicitly addressed in our study, the underlying concerns regarding total vs hemithyroidectomy were explored through discussion of the need for lifelong medication and the risk of potential recurrence.)…”

Revisiting the role of surgery in the treatment of Graves’ disease

“…In a recent, multicenter study conducted in the Netherlands, van Kinschot et al 41 performed a discrete choice experiment regarding the three management options for primary and first relapse GD presentation. The study included 286 patients and 61 clinicians.…”