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Toma de Decisiones Compartida Durante Consultas Quirúrgicas para Nódulos Tiroideos Indeterminados

Victoria Taylor^1,2, 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

Resumen

Los pacientes con nódulos tiroideos indeterminados (NTI) experimentan conflicto de decisión (CD) a pesar de percibir altos niveles de toma de decisiones compartida (TDC). Mejorar la TDC a través de ayudas para la toma de decisiones es crucial para reducir la incertidumbre del paciente en el manejo de NTI.

Palabras clave:

Bethesda PAAF citología toma de decisiones compartida tiroides nódulo tiroideo

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Área de la Ciencia:

Endocrinología; Oncología Quirúrgica; Investigación de Servicios de Salud

Sus antecedentes:

Los nódulos tiroideos indeterminados (NTI) presentan múltiples opciones de manejo, lo que a menudo causa conflicto de decisión (CD) e incertidumbre en el paciente.; La toma de decisiones compartida (TDC) es esencial para navegar por opciones médicas complejas, particularmente para afecciones como los NTI.

Objetivo del estudio:

Evaluar la participación de pacientes y médicos en la TDC para el manejo de NTI.; Examinar la relación entre la TDC y el CD percibido por el paciente en el contexto de los NTI.

Principales métodos:

Un estudio transversal multicéntrico que involucró consultas grabadas en video entre pacientes con NTI y otorrinolaringólogos.; Se utilizaron cuestionarios validados (SDM-Q-9, DCS, SDM-Q-Doc) y el instrumento MAPPIN'SDM para medir la TDC y el CD desde múltiples perspectivas.; Se incluyeron 77 pacientes y 7 cirujanos en dos hospitales importantes de Canadá.

Principales resultados:

La TDC percibida por el paciente fue alta (media=94,38), mientras que la TDC percibida por el médico fue menor (media=83,21).; La participación de la TDC determinada por el observador fue baja para los pacientes, los médicos y la díada paciente-médico.; Se encontró una correlación negativa significativa entre la TDC percibida por el paciente y el CD (r=-0,311, P=0,008), y el 13,2% de los pacientes informaron de un CD clínicamente significativo.

Conclusiones:

A pesar de la alta TDC percibida, los pacientes con NTI experimentan un conflicto de decisión significativo.; Existe la necesidad de mejorar las herramientas de apoyo a la decisión para mejorar la TDC y mitigar el CD en el manejo de NTI.; Los hallazgos subrayan la importancia de la comunicación centrada en el paciente y las ayudas para la toma de decisiones para optimizar las vías de atención para los NTI.