Barriers and Facilitators to the Choice of Active Surveillance for Low-risk Papillary Thyroid Cancer in China: A Qualitative Study Examining Patient Perspectives.

Abstract

Internationally, several clinical practice guidelines recommend active surveillance as a non-surgical management strategy for select patients with low-risk papillary thyroid carcinoma. However, patient's decision making when choosing active surveillance as a management approach is not well understood. Thus, our aim was to examine the barriers and facilitators to selecting active surveillance amongst patients with low-risk papillary thyroid carcinoma in China. Thirty-nine participants diagnosed with low-risk papillary thyroid carcinoma were purposively recruited between July - Nov 2021 for semi-structured interviews; 24 of whom rejected and 15 patients chose 'active surveillance' as a management approach in our sample. Inductive content analysis illustrated emerging themes. Audit trails, member checks and thematic discussions were used to assert rigor. Barriers and facilitators were classified as patient-related, disease-related, and external factors. Patient-related factors included patient's knowledge, attitudes and emotions. Disease-related factors included the response to having cancer, the constant state of being diseased and perceived value of the thyroid gland. External factors included the residual effects of surgery, the active surveillance protocol and physicians' recommendations. Patient's the acceptability of the active surveillance as a management approach are complex with many influencing factors. The public acceptance of active surveillance as a disease management approach needs to be improved, through the presentation of active surveillance as an evidence-based and optimized dynamic management strategy. Clinicians must address their patients' psychological struggles when patients choosing active surveillance and patients require more attention and supportive intervention.