Treatment preferences in low-risk papillary thyroid microcarcinoma: a discrete choice experiment

This study aims to assess treatment preferences among newly diagnosed low-risk papillary thyroid microcarcinoma (PTMC) patients and analyse the trade-offs they make in treatment decisions.

Cross-sectional study.

Conducted at the Fourth Affiliated Hospital of Harbin Medical University from June 2023 to April 2024, this study employed a discrete choice experiment. Participants were asked to choose among three treatment options with varying levels across seven attributes. A mixed logit model was used to analyse patient preferences, calculate the relative importance (RI) of attributes, and estimate marginal willingness to pay (mWTP). Subgroup analyses were also performed.

The final sample of 418 participants yielded 11,286 observations. The most influential attribute affecting treatment choice was the 10-year risk of disease recurrence or progression (RI = 58.4%), followed by the risk of short-term complications (RI = 8.9%), treatment type (RI = 8.5%), length of hospital stay (RI = 7.7%), need for lifelong thyroid medication (RI = 7.3%), and out-of-pocket treatment costs (RI = 6.9%). The risk of permanent voice change had minimal impact (RI = 2.4%). Regarding treatment type, participants significantly preferred thermal ablation over open surgery, while endoscopic thyroidectomy was less preferred, and active surveillance was the least favoured option. The mWTP analysis reinforced these priorities. Additionally, sociodemographic and psychological factors also influenced preferences.

These findings highlight the need for healthcare providers to clearly communicate the long-term impacts of different treatment options to support informed decision-making. They also underscore the importance of improving patient-centred care, enhancing health education, and addressing the issue of overtreatment in PTMC.