Decisional Conflicts in Patients With Low-Risk Papillary Thyroid Microcarcinomas Considering Active Surveillance

Abstract

ImportanceInternationally, active surveillance has been shown to be beneficial and safe in the management of low-risk papillary thyroid microcarcinomas. However, choosing active surveillance is a difficult treatment decision for patients with low-risk papillary thyroid microcarcinomas.ObjectiveTo identify and analyze the antecedents and mediating processes of decisional conflicts when patients consider active surveillance as an alternative to surgery.Design, Setting, and ParticipantsIn this qualitative study, semistructured interviews were conducted between April 2023 and December 2023 at 3 tertiary hospitals in China. Thirty-one participants who were diagnosed with low-risk papillary thyroid microcarcinomas, who had experienced considering active surveillance as an alternative to surgery and who scored above 25 on the decision conflict scale were purposively recruited. Inductive content analysis led to emergent themes. Data analysis was performed from April 2023 to February 2024. Methods used to protect the trustworthiness of the study results included audit trails and member checks.Main outcomes and MeasuresPatients’ experience of decisional conflicts and the antecedents and mediating processes relating to these decisional conflicts.ResultsAmong 31 participants (median [range] age, 39.2 [22-63] years; 22 [71%] were female and 9 [29%] were male), 3 themes were classified: (1) decisional conflicts in decision preparation, (2) decisional conflicts in decision-making, and (3) decisional conflicts in decision implementation. The patient’s experiences of decisional conflicts were diverse and occurred throughout the entire decision-making process. The antecedents of the decisional conflicts included personal influencing factors, system-level influencing factors, and the relational-situational context. Patients with low-risk papillary thyroid microcarcinomas interacted with these antecedents in the process of decision-making and eventually failed to mediate, leading to decisional conflicts.Conclusions and relevanceThis qualitative study found that patients with low-risk papillary thyroid microcarcinomas experienced clinically significant decisional conflicts and experienced considerable challenges and psychological problems in decision-making. The antecedents of decisional conflicts and accompanying mediating processes can provide guidance for individuals, health care professionals, and health care systems to provide decision support for patients with low-risk papillary thyroid microcarcinomas.