Factors associated with physicians’ recommendations for managing low-risk papillary thyroid cancer

Abstract

BackgroundThe 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians’ recommendations for LR-PTC. MethodsWe surveyed members of three professional societies and assessed respondents’ recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS). ResultsThe 345 respondents included 246 surgeons and 99 endocrinologists. Physicians’ preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS. ConclusionsPhysicians’ recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.