The "good cancer" paradox: Decisional conflict and unmet support needs in patients with thyroid cancer facing...

To assess decisional conflict levels and predictors among patients with differentiated thyroid cancer (DTC) choosing between open and endoscopic thyroidectomy, and to explore their decision-making experiences and decisional support needs.

A convergent parallel mixed-methods design guided by the Ottawa Decision Support Framework was employed at three tertiary hospitals in China (June 2024-June 2025). The quantitative strand surveyed 696 patients using the Decisional Conflict Scale (DCS) and Control Preferences Scale. The qualitative strand comprised semi-structured interviews with 22 purposively sampled patients, analyzed using reflexive thematic analysis. Data were integrated through joint display and meta-inference.

Over half of participants (57.9%) experienced clinically significant decisional conflict (DCS > 37.5). Lower income (β = -0.150, P < 0.001) and preference for active decision-making (β = 0.117, P = 0.004) independently predicted higher conflict. Qualitative analysis identified five themes: information needs beyond routine clinical disclosure, navigating competing values, barriers to effective decision-making, the "good cancer" paradox: when reassurance becomes invalidation, and unmet decisional support needs. Contrary to intent, the "good cancer" framing served to invalidate rather than alleviate patients' distress.

Patients with DTC experience substantial decisional conflict when choosing between surgical approaches. Decision support interventions, particularly nurse-led decision coaching, should address socioeconomic barriers, assess decisional readiness beyond stated preferences, and validate patients' concerns rather than inadvertently dismissing them through prognostic reassurance.