Open AccessTreatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study
Author(s) -
Kuta Victoria,
Forner David,
Azzi Jason,
Curry Dennis,
Noel Christopher W.,
Munroe Kelti,
Bullock Martin,
McDonald Ted,
Taylor S. Mark,
Rigby Matthew H.,
Trites Jonathan,
JohnsonObaseki Stephanie,
Corsten Martin J.
Publication year - 2021
Publication title -
oto open
Language(s) - English
Resource type - Journals
ISSN - 2473-974X
DOI - 10.1177/2473974x211015937
Subject(s) - medicine , thyroid nodules , odds ratio , socioeconomic status , cardiothoracic surgery , general surgery , thyroidectomy , nodule (geology) , thyroid cancer , population , family medicine , thyroid , surgery , paleontology , environmental health , biology
Objective Patient‐centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population. Study Design This is a retrospective cross‐sectional study of patients with Bethesda III and IV thyroid nodules. Setting Multi‐institutional. Methods Factors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients. Results A total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%‐83%; P ≤.0001). Fee‐for‐service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263‐2.175; P <. 001) and community hospital settings (OR, 1.529; 95% CI, 1.145‐2.042; P <. 001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery. Conclusion While it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient‐centered shared decision making.