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Calling thyroid cancer a "lesion" only slightly changes hypothetical treatment choices
Clinical Question
Does presenting findings as a "papillary thyroid lesion" instead of "cancer" alter hypothetical decisions regarding treatment?
Bottom line
Cancer—"the Big C"—is a frightening diagnosis. But papillary thyroid cancer, like ductal carcinoma in situ and others, is distinctly a small-C cancer. When presented with the diagnosis as a papillary thyroid "lesion" rather than "cancer" in a hypothetical situation, people were less willing to accept treatment that requires lifelong medication, less willing to accept higher-cost treatment, and less likely to trade off side effects for benefit. Otherwise it didn't make much of a difference. Regardless of what it was called, people with low health literacy preferred more aggressive treatment. This study needs to be done in patients who face a real diagnosis, rather than a hypothetical one. 2b
Reference
Study design: Cross-sectional
Funding: Government
Setting: Population-based
Synopsis
These investigators invited people who were not previously diagnosed with or treated for thyroid cancer to participate in a web-based survey. The 2054 participants (average age 46 years) were randomly assigned (concealed allocation unknown) into 2 groups and were asked, via a web-based questionnaire, 12 questions about their preferences regarding 3 alternative treatments for a disease. For one group, the disease was called "papillary thyroid cancer" and for the other group it was called a "papillary thyroid lesion." The discussion was hypothetical; participants were not given a diagnosis that applied to them and they did not have to make any actual treatment decision. In both groups, participants preferred treatment options with less frequent follow-up, lower costs, a lower chance of having adverse effects, and a lower risk of developing invasive thyroid cancer and dying of thyroid cancer. However, those asked to think about "cancer" were more willing to accept treatment that requires lifelong medication, to pay a higher cost for that treatment, and to put up with side effects. In both groups, participants with lower health literacy preferred more invasive treatment.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA