title: The role of clinicians in determining radioactive iodine use for low-risk thyroid cancer.
abstract: BACKGROUND
  There is controversy regarding the optimal management of thyroid cancer. The proportion of patients with low-risk thyroid cancer who received radioactive iodine (RAI) treatment increased over the last 20 years, and little is known about the role played by clinicians in hospital-level RAI use for low-risk disease.
  
  
  METHODS
  Thyroid surgeons affiliated with 368 hospitals that had Commission on Cancer-accredited cancer programs were surveyed. Survey data were linked to data reported to the National Cancer Database. A multivariable analysis was used to assess the relation between clinician decision makers and hospital-level RAI use after total thyroidectomy in patients with stage I, well differentiated thyroid cancer.
  
  
  RESULTS
  The survey response rate was 70% (560 of 804 surgeons). The surgeon was identified as the primary decision maker by 16% of the surgeons; the endocrinologist was identified as the primary decision maker by 69%, and a nuclear medicine, radiologist, or other physician was identified as the primary decision maker by 15%. In a multivariable analysis controlling for hospital case volume and hospital type, when the primary decision maker was in a specialty other than endocrinology or surgery, there was greater use of RAI at the hospital (P < .001). A greater number of providers at the hospital where RAI was administered and having access to a tumor board also were associated with increased use of RAI (P < .001 and P = .006, respectively).
  
  
  CONCLUSIONS
  The specialty of the primary decision maker, the number of providers administering RAI, and having access to a tumor board were associated significantly with the use of RAI for stage I thyroid cancer. The findings have implications for addressing nonclinical variation between hospitals, with a marked heterogeneity in decision making suggesting that standardization of care will be challenging.
authors: Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA. meganhay@umich.edu
authors: Megan R
authors: MR
authors: Haymart
authors: Mousumi
authors: M
authors: Banerjee
authors: Di
authors: D
authors: Yang
authors: Andrew K
authors: AK
authors: Stewart
authors: Ronald J
authors: RJ
authors: Koenig
authors: Jennifer J
authors: JJ
authors: Griggs
mesh_terms: D003131:Combined Modality Therapy; D003657:Decision Making; D006761:Hospitals; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010819:Physician's Role; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D013965:Thyroidectomy; D014481:United States
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals