title: Decisional conflict in patients considering diagnostic thyroidectomy with indeterminate fine needle aspirate cytopathology.
abstract: BACKGROUND
  Fine needle aspiration (FNA) cytopathology is the gold standard work-up for thyroid nodules. However, indeterminate lesions are encountered commonly and can lead to difficult treatment decisions. We sought to determine whether patients experienced decisional conflict surrounding management with diagnostic thyroidectomy in the setting of indeterminate FNA results.
  
  
  METHODS
  Patients with indeterminate results of thyroid nodule FNA were prospectively enrolled. All consultations were carried out by three otolaryngologists in a consistent manner. After consultation, participants completed a demographics form and the Decisional Conflict Scale (DCS) questionnaire.
  
  
  RESULTS
  Thirty-five patients (28 female) between the ages of 30 and 88 years (mean age 54.89) participated. The median total DCS score was 10.94 (interquartile range, 4.69-25.0). Twelve patients (34%) scored at or above 25 on the DCS, indicating clinically significant level of decisional conflict. Patients reported feeling significantly more confident about their decision after the surgical consultation compared to before the consultation (p = 0.00). The total DCS score was significantly negatively correlated with self-reported confidence after the consultation (r = -0.421, p = 0.012).
  
  
  CONCLUSIONS
  Many patients experienced clinically significant decisional conflict when considering thyroidectomy for management of a thyroid nodule with indeterminate cytopathology. Future research should be directed at developing decision support tools for this patient group, and exploring the impact of decisional conflict on health outcomes.
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada. b.taylor@dal.ca.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Taylor
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada. drrobhart@gmail.com.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hart
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada. mhrigby@dal.ca.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Rigby
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada. jonathan.trites@cdha.nshealth.ca.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Trites
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada. smarktaylor@eastlink.ca.
authors.forename: S Mark
authors.initials: SM
authors.lastname: Taylor
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada. Paul.Hong@iwk.nshealth.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods / Q000523:psychology*