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Cancer. 2015 Oct 15;121(20):3717-26. doi: 10.1002/cncr.29548. Epub 2015 Jul 20.

Thyroid cancer patient perceptions of radioactive iodine treatment choice: Follow-up from a decision-aid randomized trial.

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Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada.
Department of Medicine, St. Michael's Hospital/University of Toronto, Toronto, Canada.
Department of Psychosocial Oncology, University Health Network/University of Toronto, Toronto, Canada.
Department of Radiation Oncology, University Health Network/University of Toronto, Toronto, Canada.
Department of Surgery, University Health Network/University of Toronto, Toronto, Canada.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
Dalla Lana School of Public Health, University of Toronto/Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada.
Department of Otolaryngology and Head and Neck Surgery, University Health Network/University of Toronto, Toronto, Canada.



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.


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.


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.


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.


decision aids; decision making; decision support techniques; iodine radioisotopes; patient satisfaction; qualitative research; thyroid cancer

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