Browsing by Author "Roman, Benjamin R."

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    Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey
    (Endocrine Society, 2021) Pitt, Susan C.; Yang, Nan; Saucke, Megan C.; Marka, Nicholas; Hanlon, Bret; Long, Kristin L.; McDow, Alexandria D.; Brito, J.P.; Roman, Benjamin R.; Surgery, School of Medicine
    Context: Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States. Objective: This work aimed to understand factors associated with the adoption of AS. Methods: We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for 2 hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Outcome measures included adoption of AS (nonadopters vs adopters, who respectively did not recommend or recommended AS at least once; and partial vs full adopters, who respectively recommended AS for one or both cases). Results: The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Nonadopters (45.7%) were significantly (P < .001) less likely than adopters to practice in academic settings, see more than 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (P = .04), know how to determine whether a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Nonadopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (P = .03) and more likely to be anxious (P = .04), have reservations (P = .03), and have concerns about the psychological burden (P = .009) of AS. Few respondents (3.2%) believed patients were aware of AS. Conclusion: Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.
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    Factors Associated with Physicians’ Recommendations for Managing Low-Risk Papillary Thyroid Cancer
    (Elsevier, 2021) McDow, Alexandria D.; Roman, Benjamin R.; Saucke, Megan C.; Jensen, Catherine B.; Zaborek, Nick; Jennings, Jamia Linn; Davies, Louise; Brito, Juan P.; Pitt, Susan C.; Surgery, School of Medicine
    Background: The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians' recommendations for LR-PTC. Methods: We surveyed members of three professional societies and assessed respondents' recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS). Results: The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians' preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS. Conclusions: Physicians' recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.