The Influence of Cosmetic Concerns on Patient Preferences for Approaches to Thyroid Lobectomy: A Discrete Choice Experiment

Sukpanich, Rupporn; Sanglestsawai, Santi; Seib, Carolyn D.; Gosnell, Jessica E.; Shen, Wen T.; Roman, Sanziana A.; Sosa, Julie Ann; Duh, Quan‐Yang; Suh, Insoo

doi:10.1089/thy.2019.0821

Cited by 16 publications

(6 citation statements)

References 19 publications

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“…They similarly concluded that presence of a neck scar also influenced patient decision-making, but this was dependent on patient age with younger patients preferring a scarless approach. 30 This has important implications in the current study as the majority of respondents were under the age of 39 which may have skewed the preference for a scarless approach. Nonetheless, this has very interesting and complex applications for the primary surgeon.…”

Section: Discussionmentioning

confidence: 94%

Evaluation of Preference and Utility Measures for Transoral Thyroidectomy

Samargandy

Philteos

et al. 2022

Ann Otol Rhinol Laryngol

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Background: Traditional, trans-cervical thyroidectomy results in the presence of a neck scar, which has been shown to correlate with lower quality of life and lower patient satisfaction. Transoral thyroid surgery (TOTS) has been utilized as an alternative approach to avoid a cutaneous incision and scar by accessing the neck and thyroid through the oral cavity. This study was designed to evaluate patient preference through health-state utility scores for TOTS as compared to conventional trans-cervical thyroidectomy. Methods: In this cross-sectional study, patient preferences were elicited for TOTS and trans-cervical thyroidectomy with the use of an online survey. Respondents were asked to consider 4 hypothetical health scenarios involving thyroid surgery with varying approaches. Health-state utility scores were elicited using visual analog scale and standard gamble exercises. Results: Overall, 516 respondents completed the survey, of whom 261 (50.6%) were included for analysis, with a mean age of 41.5 years (SD 14.9 years), including 171 (65.5%) females. Health utility scores were similar for TOTS and conventional transcervical techniques. Statistically significant differences in the standard gamble utility score were noted for gender and ethnicity across all scenarios. Comparisons of visual analog score utilities were not statistically significant based on respondent demographics. Conclusion: Preferences for TOTS and trans-cervical thyroidectomy did not significantly differ in the current study. Females and white ethnicity indicated stronger preference for a TOTs approach compared to males and other ethnicities, respectively. Some literature suggests certain types of patients who might prefer minimally invasive thyroidectomy more so than other patients—in keeping with the current findings of this study.

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Section: Discussionmentioning

confidence: 94%

Evaluation of Preference and Utility Measures for Transoral Thyroidectomy

Samargandy

Philteos

et al. 2022

Ann Otol Rhinol Laryngol

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“…A study reported that young patients were willing to pay over USD 2000 and travel up to 700 miles to avoid a neck incision. 31 Because of the rare threat to survival by papillary thyroid carcinoma, an increasing number of patients, including elderly people, attach more importance to cosmetic outcomes and postoperative quality of life. Nonetheless, a visible scar negatively impacts the satisfaction and quality of life of patients, especially in the Asian population, 32 which is a disadvantage of open surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…Fortunately, the extra 4000¥ is affordable and acceptable for patients. A study reported that young patients were willing to pay over USD 2000 and travel up to 700 miles to avoid a neck incision 31 . Because of the rare threat to survival by papillary thyroid carcinoma, an increasing number of patients, including elderly people, attach more importance to cosmetic outcomes and postoperative quality of life.…”

Section: Discussionmentioning

confidence: 99%

Is transoral endoscopic thyroidectomy safe for total thyroidectomy compared to open thyroidectomy? A propensity‐score matched cohort study with papillary thyroid carcinoma

Liu

Wang

et al. 2023

Journal of Surgical Oncology

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BackgroundTransoral endoscopic thyroidectomy via vestibular approach (TOETVA) has become increasingly popular in the treatment of papillary thyroid cancer (PTC). This study aimed to describe the safety and feasibility of total thyroidectomy between the TOETVA and open thyroidectomy (OT) approaches for the treatment of patients with PTC.MethodsWe retrospectively reviewed 780 consecutive patients suffering from PTC that had undergone total thyroidectomy using TOETVA (n = 107) and OT (n = 673) between April 2016 and December 2021 at our institute. Afterward, a total of 101 matched patients' surgical outcomes were compared using propensity score matching (PSM) analysis.ResultsBefore PSM, the patients in the TOETVA group were younger (p < 0.001), had a lower body mass index (p < 0.001) and a greater female population (p < 0.001). After PSM, the TOETVA group was associated with significantly longer operative time (p < 0.001), greater blood loss (p < 0.001), total drainage amount (p < 0.001), higher C‐reaction protein level (p < 0.001), better cosmetic satisfaction (p < 0.001) and quality of life (p < 0.001) and lower scar self‐consciousness (p < 0.001). There was no statistical difference between the groups in the rate of parathyroid autotransplantation and bilateral lymph node dissection, the positivity of lymph node metastasis, number of dissected lymph nodes and positive lymph nodes, multifocality, postoperative level of blood calcium and parathyroid hormone (PTH), rate of PTH < 15 ng/mL, visual analog scale score, duration of hospital stay, complications, mean thyroid stimulating hormone (TSH)‐stimulated Tg level before radioactive iodine, mean Tg level without TSH stimulation, and the proportion of serum Tg level of <1.ConclusionTOETVA is a safe and feasible technique for better cosmetic effects and similar surgical outcomes compared to conventional open surgery for the studied patients that required total thyroidectomy.

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“…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.)…”

Section: Discussionmentioning

confidence: 99%

Patient Experiences With Thyroid Nodules: A Qualitative Interview Survey

et al. 2023

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Objective To qualitatively explore the broad set of preferences and attitudes patients have about thyroid nodules, which influence the decision‐making process. Study Design A descriptive survey design was administered as interviews. Setting Outpatient thyroid surgery clinic. Methods Semistructured interviews were conducted with 20 patients presenting for initial evaluation of thyroid nodules at a surgeon's office. Probative, open‐ended questions were posed regarding diagnosis, treatment, risk attitudes, and the decision‐making process. Thematic analysis was used to develop code‐transcribed interviews, and an iterative refinement resulted in underlying themes. Results During the diagnostic process, patients integrated emotional responses (fear, anxiety, and shock) with rationale concerns (likelihood of cancer, risk assessment), and ultimately relied heavily on expert opinion and recommendation. Contextualization with other personal or familial health problems served as helpful touchstones for decision‐making. Overtreatment and overdiagnosis were not commonly discussed. When thinking about potential therapies, there was a strong bias to action rather than surveillance among patients. Surgical risk and the possibility of lifelong medication, however, were strong motivators for a subset of patients to seek nonsurgical alternatives. Conclusion Patients describe a decision‐making process that incorporates emotional response and rational consideration of risks, contextualized within the personal experience and physician expertise. The bias for action and intervention is strong, and most patients strongly weighted physicians' recommendations. Themes from this qualitative analysis may serve as the backbone for future stated preference research pertaining to thyroid disease.

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The Influence of Cosmetic Concerns on Patient Preferences for Approaches to Thyroid Lobectomy: A Discrete Choice Experiment

Cited by 16 publications

References 19 publications

Evaluation of Preference and Utility Measures for Transoral Thyroidectomy

Evaluation of Preference and Utility Measures for Transoral Thyroidectomy

Is transoral endoscopic thyroidectomy safe for total thyroidectomy compared to open thyroidectomy? A propensity‐score matched cohort study with papillary thyroid carcinoma

Patient Experiences With Thyroid Nodules: A Qualitative Interview Survey

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