Do papillary thyroid cancer patients using a computerized decision aid perceive themselves to be better informed about radioactive iodine treatment choice?

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 459-496-Thyroid Neoplasia & Case Reports
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-474
Annie Mary Sawka*1, Asima Naeem2, Sharon Straus3, James D Brierley1, Richard W Tsang1, Lorne Rotstein1, Shereen Z Ezzat1 and David P Goldstein1
1University Health Network/University of Toronto, Toronto, ON, Canada, 2University Health Network, Toronto, ON, Canada, 3University of Toronto, Toronto, ON, Canada
Background:  Decision-making on the post-surgical use of radioactive iodine (RAI) for remnant ablation or adjuvant treatment of low risk papillary thyroid cancer (PTC) is complex.  We recently conducted a randomized controlled trial of a patient-directed computerized decision aid, intended to be used as an adjunct to physician counselling, in educating low risk PTC patients on the choice of accepting or rejecting adjuvant radioactive iodine treatment.  This decision aid has been shown to improve patients’ medical knowledge and reduce decisional conflict (J Clin Oncol 2012 30:2906-2911).  It is not known how this DA impacts patients’ perceptions on how well informed they were about the decision.

Methods:  We randomized 74 early stage PTC patients in a 1:1 ratio, to either exposure to a computerized decision aid (DA), or no DA, around the time of post-surgical RAI treatment decision-making.  All patients received usual care and counselling from their treating physicians.  We contacted patients by phone more than a year after randomization and evaluated patients’ perceptions on how well informed they were about the decision to take RAI or not.  Participants were asked to grade, on a 5-point Likert scale, their level of agreement with 4 questions, including whether they made an informed choice, whether they were aware of the available choices, whether they knew the benefits of the treatment, and whether they knew the risks and side effects of the treatment.  We compared scores between the DA and no DA groups, using unpaired Student’s t-tests.

Results:  To date, we have completed follow-up with 70/74 (95%) of the study population, including data from 58 women and 12 men, a mean of 16.5 months after randomization (standard deviation, SD 2.2).  Patients in the DA group had significantly superior measurements, compared with the no DA group, for the perceptions on: a) having made an informed RAI treatment choice (p=0.008), b) being aware of the treatment choices (p=0.009), c) knowing the benefits of RAI treatment (p=0.020), and d) knowing the risks and side effects of RAI treatment (p=0.001).

 Conclusions:  A computerized DA improves patients’ perceptions on feeling well-informed about RAI treatment choice, when evaluated at long-term follow-up.  Decision aids may be helpful adjuncts, in addition to physician counselling, for educating low risk PTC patients about RAI treatment options.

Nothing to Disclose: AMS, AN, SS, JDB, RWT, LR, SZE, DPG

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: This study was supported by an operating grant from the Canadian Institutes of Health Research (Institute of Cancer Research, Priority Announcement: Knowledge Translation).  AMS holds a Chair in Health Services Research from Cancer Care Ontario, funded by the Ontario Ministry of Long-term Care.  SS holds a Tier 1 Canada Research Chair.