Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2025
A Qualitative Study of Clinician Barriers and Facilitators to De-escalation of Thyroid Stimulating Hormone Suppression in Thyroid Cancer Survivors.
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Francis-Levin Nina, Tan Chiu Yi, Gay Brittany L, Haymart Megan R, Papaleontiou Maria
Аннотация
OBJECTIVE: Most patients with differentiated thyroid cancer have low-risk disease and excellent prognosis. Thyroid stimulating hormone (TSH) suppression therapy after initial treatment may be unnecessary and potentially harmful for survivors with recurrence-free, low- or intermediate-risk thyroid cancer. Little is known about clinician-reported barriers and facilitators to reducing thyroid cancer survivors' thyroid hormone dose with the goal of aiming for TSH in the normal reference range.
METHODS: Clinicians from the fields of endocrinology (n = 8) and primary care (n = 7) were recruited through convenience/snowball sampling to participate in semistructured focus groups. Data collection and analyses were informed by the Theoretical Domains Framework for behavior change, a valuable integrative framework which can facilitate comprehensive assessment of behavioral determinants in qualitative studies. Deductive coding and inductive thematic analysis were conducted.
RESULTS: Participants were majority female (73%) and averaged 14 years in clinical practice (range, 1-22). Barriers and facilitators emerged at the patient-level, clinician-level, and system-level. Key clinician-reported barriers included patient distress/anxiety and misinformation, unclear shared patient survivorship goals and plans between specialties, and clinic visit time constraints. Clinician-reported facilitators included building a trusting relationship, delivery of patient-centered education, and communication and collaboration between specialties to establish shared long-term survivorship plans.
CONCLUSIONS: We identified barriers and facilitators to de-escalating TSH suppression therapy in thyroid cancer survivors at multiple levels. Understanding these factors will enable clinicians to provide high-value, patient-centered care in order to reduce overtreatment, patient harm and improve quality of life in thyroid cancer survivors.
METHODS: Clinicians from the fields of endocrinology (n = 8) and primary care (n = 7) were recruited through convenience/snowball sampling to participate in semistructured focus groups. Data collection and analyses were informed by the Theoretical Domains Framework for behavior change, a valuable integrative framework which can facilitate comprehensive assessment of behavioral determinants in qualitative studies. Deductive coding and inductive thematic analysis were conducted.
RESULTS: Participants were majority female (73%) and averaged 14 years in clinical practice (range, 1-22). Barriers and facilitators emerged at the patient-level, clinician-level, and system-level. Key clinician-reported barriers included patient distress/anxiety and misinformation, unclear shared patient survivorship goals and plans between specialties, and clinic visit time constraints. Clinician-reported facilitators included building a trusting relationship, delivery of patient-centered education, and communication and collaboration between specialties to establish shared long-term survivorship plans.
CONCLUSIONS: We identified barriers and facilitators to de-escalating TSH suppression therapy in thyroid cancer survivors at multiple levels. Understanding these factors will enable clinicians to provide high-value, patient-centered care in order to reduce overtreatment, patient harm and improve quality of life in thyroid cancer survivors.