Nickel B, et al. - Experts sought to ascertain factors that influence treatment preferences for patients with papillary thyroid cancer (PTC), and trade-offs in treatment factors people are willing to accept, and to understand how terminology influences preferences and benefit-harm trade-offs. An important contribution was made by this study in understanding how attributes of treatment options, terminology, and patient characteristics, in particular, health literacy, influence treatment decision making for PTC.

Methods

• Authors assessed the preferences in PTC treatment using a discrete choice experiment (DCE) conducted as a web-based survey using an existing public online research panel.
• They randomized the participants to receive 1 of 2 frames of information based on the terminology used to describe the condition: “cancer” or “lesion.”
• The participants made a choice between 3 treatment options for PTC (thyroidectomy, hemithyroidectomy, and active surveillance).
• They conducted the analyses using a mixed logit model.
• Treatment preference was the main outcome variable; attributes of treatment options and sociodemographic characteristics were explanatory variables.

Results

• As per data, 2,054 participants (993 [48.3%] men and 1061 [51.7%] women; mean [SD] age, 46.0 [16.5] years) with no history of thyroid cancer completed the DCE.
• Options with less frequent follow-up, lower out-of-pocket costs, lower chances of having voice and calcium level problems, and a lower risk of developing invasive thyroid cancer and of dying of thyroid cancer were preferred by the participants.
• Results demonstrated that when trading benefits against harms, participants were willing to accept a higher number of extra patients experiencing adverse effects to avoid a thyroid cancer death when the condition was described as a cancer compared with a lesion.
• Specifically, more patients requiring lifelong medication (mean, 273; 95% CI, 207-339 vs mean, 98; 95% CI, 66-131), experiencing calcium problems (mean, 110; 95% CI, 77-144 vs mean, 56; 95% CI, 55-58), and fatigue (mean, 958; 95% CI, 691-1224 vs mean, 469; 95% CI, 375-564) were expected more willingly by the participants for whom the condition was described as a cancer.
• For both the cancer and lesion terminology, they noted a consistent association of health literacy with preferences for treatment options.
• A significantly lower preference for less invasive treatment options was seen in those with lower health literacy.