Surgeon acceptability of a choice architecture intervention to promote use of thyroid lobectomy for low-risk thyroid...

With the 2025 American Thyroid Association guidelines supporting de-escalation of total thyroidectomy for low-risk thyroid cancer, interventions that distill guideline recommendations and facilitate rapid adoption are needed. This study evaluated the acceptability of a novel surgeon-directed intervention designed to increase thyroid lobectomy use.

This convergent triangulation mixed-methods study enrolled thyroid surgeons using purposive and snowball sampling. Acceptability of a choice architecture-based intervention was quantified using the validated Theoretical Framework of Acceptability, which measures affective attitude, self-efficacy, perceived effectiveness, intervention coherence, burden, opportunity cost, and ethicality. Semistructured qualitative interviews explored initial impressions, strengths and weaknesses, and usability of the intervention and were analyzed deductively using the Theoretical Framework of Acceptability constructs.

Twenty-one participants completed the Theoretical Framework of Acceptability survey, and 12 participated in interviews. Participants were 47.1 ± 10.0 years old, mostly male (61.9%), White (71.4%), and self-identified as endocrine surgeons (71.4%). Theoretical Framework of Acceptability scores demonstrated good general acceptability, positive attitudes, and confidence in ability to use the intervention. Scores also revealed strong perceived effectiveness and clarity about how the intervention could improve surgical decision-making with minimal concern for the burden of incorporating into practice or ethical consequences. Participants noted the intervention could be "helpful…especially for low-volume surgeons" and appreciated both the "appropriate amount" of information and discussion of benefits and risks that was "easier than having to do it all on [their] own."

This novel intervention was acceptable among thyroid surgeons across all domains of the Theoretical Framework of Acceptability. Participants valued the intervention's practicality, clarity, and usability in guiding patient discussions and supporting decision-making for low-risk thyroid cancer.