Communication of Voice-Related Complications in Thyroidectomy: A Qualitative Analysis.

OBJECTIVE

This study aims to characterize patient-surgeon discussions of voice-related complications during thyroidectomy for low-risk thyroid cancer.

STUDY

DESIGN

A qualitative study.

SETTING

Three academic medical centers.

METHODS

Pre-operative clinic visits between 14 surgeons (6 otolaryngologists and 8 endocrine surgeons) and 49 patients with low-risk (cT1-2, N0) thyroid cancer were audio-recorded and transcribed. Qualitative analysis was used to evaluate surgeon counseling strategies and patient concerns related to voice.

RESULTS

Patients aged from 20 to 77 years old were predominantly female (77.6%) and white (89.9%). Surgeons presented risk with negative framing and numerical percentages (1%-4%) and/or qualified the risk as "low" or "small" for a lobectomy, but a "much bigger deal" for bilateral nerve injury in total thyroidectomy. At a minimum, surgeons referred to voice dysfunction as "voice change." Some further described "hoarseness" or the "inability to project voice." Other surgeons imitated what voice dysfunction would sound like. A few surgeons probed the importance of voice to a patient's life. One surgeon imparted that having a voice-related complication "can be really emotional." Patients responded with varying degrees of concern about voice changes after surgery, from feeling "super concerned … about losing [their] voice" to feeling "ok" with it "as long as [they're] around to deal with it."

CONCLUSION

Significant variability exists in how surgeons describe and set expectations about voice-related complications. The degree to which patients value voice-related outcomes differed based on their occupation and hobbies, but this was tempered by their cancer diagnosis. Further research is needed to identify optimal disclosure of voice-related risks and expectations.