Participants report decision not to intervene is often met with non-reassuring, unsupportive response
FRIDAY, March 10, 2017 (HealthDay News) — Patients with thyroid cancer who decide not to intervene experience anxiety, may feel isolated, and are at risk of disengaging from health care, according to a study published online March 9 in JAMA Otolaryngology-Head and Neck Surgery.
Louise Davies, M.D., from the Department of Veterans Affairs Medical center in White River Junction, Vt., and colleagues describe the experience of patients who independently self-identify as having an overdiagnosed cancer and choose not to intervene. Semi-structured interviews were conducted among 22 community-dwelling adults who had an incidentally identified thyroid finding known or suspected to be malignant.
The researchers found that 18 of the people interviewed had elected not to intervene on their thyroid finding, and they had been living with the decision for a mean of 39 months. Twelve of the 18 participants reported significant anxiety about cancer progression, but issues such as precision in diagnostic testing and the varied behavior of cancer were reasons for choosing nonintervention. Twelve participants reported that their decisions were met with non-reassuring and unsupportive responses. Only three participants reported success in connecting with others about the experience, although 14 individuals wished to do so. Fifteen participants managed their experience through secret keeping.
“Successful de-escalation of intervention for patients who self-identify as having overdiagnosed cancers requires explicit social and health system support and education,” the authors write. “We hypothesize that improved support would also promote quality of care by increasing the likelihood that patients could be kept engaged for recommended surveillance.”
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