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Endocrine Surgery

Preference Phenotypes in Thyroid Nodule Management: A Patient Segmentation Approach

Monday, October 2, 2023
3:45 PM - 3:51 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • MN

    Matthew R. Naunheim, MD, MBA

    Assistant Professor
    Massachusetts Eye and Ear Infirmary/Harvard Medical School
    Boston, MA, United States

    • Author(s)

  • Mv

    Manuela von Sneidern, MD

    Department of Otolaryngology – Head and Neck Surgery, New York University Grossman School of Medicine, USA

    • Presenting Author(s)

  • MH

    Molly N. Huston, MD

    Assistant Professor
    Washington University in St. Louis
    Saint Louis, MO, United States

  • GR

    Gregory W. Randolph, MD

    Professor
    Massachusetts Eye and Ear Infirmary Harvard
    Boston, MA, United States

    • Author(s)

  • MS

    Mark G. Shrime, MD, PhD, MPH

    Instructor in Otolaryngology
    Massachusetts Eye and Ear Infirmary
    Boston, Massachusetts, United States

Disclosure(s):
Manuela von Sneidern, MD: No relevant relationships to disclose.
Mark G. Shrime, MD, PhD, MPH: No relevant relationships to disclose.
Introduction: Patient preferences regarding treatment of thyroid nodules is poorly understood. Our objective is to (1) employ a discrete choice experiment (DCE) to explore risk tradeoffs among respondents considering treatment of thyroid nodules, and (2) to segment respondents into preference phenotypes.

Methods: A DCE including 5 key attributes (risk of cancer, risk to voice, need for incision, need for medication, need for follow up) was constructed and piloted with patient and physician input. A final DCE including 8 choice tasks, demographics, medical history, and risk tolerance assessment was administered to participants with and without thyroid disease. Participants chose between hypothetical scenarios varying across attributes. A multinomial logit model was used for primary analysis. Latent class analysis (LCA) evaluated for preference phenotypes across the sample.

Results: 1026 respondents were included; 480 had previous thyroid disease. Risk aversion was associated with increasing age (p < 0.001), female gender (p < 0.001), and limited education (p=0.038), but not previous thyroid disease. Cancer risk had the biggest impact on decision-making. Of the total possible utility change from making a decision about a thyroid nodule, 47.8% was attributable to variations in cancer risk; 20.0% from medication management; 14.9% from voice changes; 12.7% from presence of a scar; and 4.6% from need for follow up. LCA demonstrated three subgroups with distinct preference phenotypes: the largest group (64.2%) made choice decisions primarily based on cancer risk; the middle group (18.2%) chose based on aversion to taking medication; the smallest group (17.7%) factored in all attributes, with relatively even consideration of medication need and cancer risk.

Conclusions: Cancer risk, and to a lesser extent the need to take medication after thyroid surgery, factor into patient decision-making when considering treatment of thyroid nodules. Distinct preference phenotypes were demonstrated, however, reinforcing the need for rigorous individual preference assessment before treatment of thyroid disorders.