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Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
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Shared Decision-Making During Surgical Consultations for Indeterminate Thyroid Nodules.

Victoria Taylor1,2, Travis Pickett3, Brooke Turner4

  • 1Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.

Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'Oto-Rhino-Laryngologie Et De Chirurgie Cervico-Faciale
|December 30, 2025
PubMed
Summary

Patients with indeterminate thyroid nodules (ITNs) experience decisional conflict (DC) despite perceived high levels of shared decision-making (SDM). Enhancing SDM through decision aids is crucial for reducing patient uncertainty in ITN management.

Keywords:
BethesdaFNAcytologyshared decision-makingthyroidthyroid nodule

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Health Services Research

Background:

  • Indeterminate thyroid nodules (ITNs) present multiple management options, often causing decisional conflict (DC) and patient uncertainty.
  • Shared decision-making (SDM) is essential for navigating complex medical choices, particularly for conditions like ITNs.

Purpose of the Study:

  • To assess patient and physician engagement in SDM for ITN management.
  • To examine the relationship between SDM and patient-perceived DC in the context of ITNs.

Main Methods:

  • A multi-institutional, cross-sectional study involving video-recorded consultations between patients with ITNs and otolaryngologists.
  • Utilized validated questionnaires (SDM-Q-9, DCS, SDM-Q-Doc) and the MAPPIN'SDM instrument to measure SDM and DC from multiple perspectives.
  • Included 77 patients and 6 surgeons across two major Canadian hospitals.

Main Results:

  • Patient-perceived SDM was high (mean=94.38), while physician-perceived SDM was lower (mean=83.21).
  • Observer-determined SDM involvement was low for patients, physicians, and the patient-physician dyad.
  • A significant negative correlation was found between patient-perceived SDM and DC (r=-0.311, P=0.008), with 13.2% of patients reporting clinically significant DC.

Conclusions:

  • Despite high perceived SDM, patients with ITNs experience significant decisional conflict.
  • There is a need for improved decision support tools to enhance SDM and mitigate DC in ITN management.
  • Findings underscore the importance of patient-centered communication and decision aids for optimizing care pathways for ITNs.