Shared Decision-Making During Surgical Consultations for Indeterminate Thyroid Nodules
Bibliographic record
Abstract
Importance Several feasible management options exist for indeterminate thyroid nodules (ITNs), which can lead to decisional conflict (DC) and uncertainty in patients. Objective To investigate patient and physician participation in shared decision-making (SDM) during the management of ITNs and the association of SDM with patient-perceived DC. Study Design Multi-institutional, cross-sectional, multiple methods study. Setting The Queen Elizabeth II Health Science Centre (Halifax, Nova Scotia) from October 2020 to June 2023 and The Ottawa Hospital (Ottawa, Ontario) from November 2022 to June 2023. Intervention and Exposures Patients with ITNs scheduled for an initial surgical consultation with an Otolaryngologist were included. Consultations were video-recorded using discreet cameras within clinic rooms at both sites. Management options discussed at both sites included repeat fine needle aspiration biopsy, ultrasound surveillance, surgery, and molecular testing. Main Outcome Measures Patient-perceived SDM was measured by the SDM Questionnaire-9 (SDM-Q-9) and perceived DC by the DC Scale (DCS). Surgeons’ perceptions of SDM were measured by the SDM-Q-Doc. Observer-determined SDM was reported using the multifocal approach to sharing in SDM (MAPPIN’SDM) instrument. Results Seventy-seven patients and 6 surgeons were included. Patient-perceived SDM was high [mean = 94.38, standard deviation (SD) = 7.61], while physician-perceived SDM was lower in comparison (mean = 83.21, SD = 9.14). Observer-determined SDM involvement of the patient (mean = 0.73, SD = 1.08), physician (mean = 1.71, SD = 1.33), and patient-physician dyad (mean = 1.75, SD = 1.27) was low. Clinically significant DC (DCS score ≥25) was reported by 13.2% of patients. There was a medium negative correlation between patient-perceived SDM involvement and DC (Pearson r = −0.311, P = 0.008). Patient-perceived SDM did not differ by clinicodemographic factors. Conclusion While patients and physicians perceived high levels of SDM, patients with ITNs are faced with difficult management decisions leading to DC. Relevance These findings highlight the need for developing decision-aids to support SDM and reduce DC in the management of ITNs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.036 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".