title: Thyroid cancer patient perceptions of radioactive iodine treatment choice: Follow-up from a decision-aid randomized trial.
abstract: BACKGROUND
  Patient decision aids (P-DAs) inform medical decision making, but longer term effects are unknown. This article describes extended follow-up from a thyroid cancer treatment P-DA trial.
  
  
  METHODS
  In this single-center, parallel-design randomized controlled trial conducted at a Canadian tertiary/quaternary care center, early-stage thyroid cancer patients from a P-DA trial were contacted 15 to 23 months after randomization/radioactive iodine (RAI) decision making to evaluate longer term outcomes. It was previously reported that the use of the computerized P-DA in thyroid cancer patients considering postsurgical RAI treatment significantly improved medical knowledge in comparison with usual care alone. The P-DA and control groups were compared for the following outcomes: feeling informed about the RAI treatment choice, decision satisfaction, decision regret, cancer-related worry, and physician trust. In a subgroup of 20 participants, in-depth interviews were conducted for a qualitative analysis.
  
  
  RESULTS
  Ninety-five percent (70 of 74) of the original population enrolled in follow-up at a mean of 17.1 months after randomization. P-DA users perceived themselves to be significantly more 1) informed about the treatment choice (P = .008), 2) aware of options (P = .009), 3) knowledgeable about treatment benefits (P = .020), and 4) knowledgeable about treatment risks/side effects (P = .001) in comparison with controls. There were no significant group differences in decision satisfaction (P = .142), decision regret (P = .199), cancer-related worry (P = .645), mood (P = .211), or physician trust (P = .764). In the qualitative analysis, the P-DA was perceived to have increased patient knowledge and confidence in decision making.
  
  
  CONCLUSIONS
  The P-DA improved cancer survivors' actual and long-term perceived medical knowledge with no adverse effects. More research on the long-term outcomes of P-DA use is needed.
authors.affiliation: Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
authors.affiliation: Department of Medicine, St. Michael's Hospital/University of Toronto, Toronto, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Straus
authors.affiliation: Department of Psychosocial Oncology, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.affiliation: Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: Lineke
authors.initials: L
authors.lastname: Heus
authors.affiliation: Department of Radiation Oncology, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: James D
authors.initials: JD
authors.lastname: Brierley
authors.affiliation: Department of Radiation Oncology, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Tsang
authors.affiliation: Department of Surgery, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: Lorne
authors.initials: L
authors.lastname: Rotstein
authors.affiliation: Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
authors.affiliation: Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: Phillip
authors.initials: P
authors.lastname: Segal
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.affiliation: Dalla Lana School of Public Health, University of Toronto/Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Thorpe
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, University Health Network/University of Toronto, Toronto, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D002170:Canada; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D011878:Radiotherapy / Q000523:psychology*; D013964:Thyroid Neoplasms / Q000523:psychology / Q000532:radiotherapy*
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals
keywords: decision aids; decision making; decision support techniques; iodine radioisotopes; patient satisfaction; qualitative research; thyroid cancer