Enabling Patient Empowerment in Treatment Decisions for Thyroid Cancer—Reply

Abstract

COMMENT & RESPONSEIn Reply In response to our study 1 on the influence of patient preference in physician decision-making in thyroid cancer, Kaul and Garg offered several insights on our study limitations and the value of shared decision-making. Nonetheless, several studies have shown that the current state of shared decisionmaking in thyroid cancer care fails to meet the needs of our patients. First, our previous study 2 highlighted the lack of consensus among physicians regarding the risks, benefits, and optimal treatment of thyroid cancer. Thus, information and treatment recommendations patients receive will vary by which physician they happen to encounter. Second, previous studies have shown that physicians can often fail to consider patients' key decision factors and misjudge what patients with thyroid cancer value. 3 The solution is a standardized decision aid that educates patients and empowers them to prioritize their own preferences and values. Physicians should also be encouraged to be transparent about nonclinical factors that may influence decision-making (eg, local practice patterns, personal biases, availability of active surveillance). Thyroid nodule conversation aids and information provision have been associated with increased involvement of patients in the decision-making process, clinician satisfaction, decreased decisional conflict, and fewer thyroid biopsies. 4,5 Finally, educational efforts at both the institutional and national/societal level may help disseminate data on the significance of patient values and preferences in thyroid cancer treatment.