PSAT246 Decision Making for Patients with Thyroid Nodules: Understanding the Patient's Experience
Authors: Patel Chavez Chandani , Leiva Eddison Godinez , Bagautdinova Diliara , Hidalgo Jessica , Hartasanchez Sandra , Barb Diana , Danan Deepa , Dziegielewski Peter , Edwards Catherine , Hughley Brian , Srihari Ashok , Subbarayan Sreevidya , Regina Castro , Dean Diana , Morris John , Mabel Ryder , Marius Stan , Hargraves Ian , Shepel Kathryn , Campana Juan Brito , Bylund Carma , Debbie Treise , Montori Victor , Ospina Naykky Singh 
Published: November 2022

Abstract

Background
We recently developed a Thyroid NOdule conversation aid (TNOC), a conversation tool that supports communication about management options between patients with thyroid nodules and their clinicians. TNOC uses an interactive electronic interface to support conversations about thyroid cancer risk in patients with thyroid nodules and management options. In a pilot study, the use of TNOC in the clinical encounter was associated with improvement in the quality of diagnostic conversations.
Research question: The aim of the study was to evaluate the patient's experience when receiving care using TNOC.

Methods
Prospective study conducted in two academic centers in the U.S. We included adult patients presenting for the evaluation of thyroid nodules and using TNOC in the encounters with their clinicians. Patients that were hyperthyroid, pregnant or had records of previous biopsy were excluded. Patient demographics and clinical features were obtained through electronic health record review. We conducted post-visit semi-structured interviews to assess patients’ experiences using TNOC. The semi-structured interview was developed following constructs included in the Consolidated Framework for Implementation Research. Qualitative analysis was conducted following the constant comparative method to identify emerging themes related to the patient experiences using TNOC. After an initial group of themes were identified, a final set of themes was derived based on prevalence and salience, following an iterative process by two coders.

Results
53 patients were enrolled in the study and 49 completed the post-visit interview. Most patients were women (N -42, 79%) and white (N-47, 89%) with a median age of 62 years (Interquartile range, 53-70). The median size of the thyroid nodules was 2.3 cm (Interquartile range, 1.3, 3.0) and 45% were ACR-TIRADS 4 or 5 (N-24). Most nodules were found incidentally (N-37, 70%).
In the qualitative assessment, the layman terms included in TNOC, the structured, step-wise and visual presentation of information were considered positively by patients. The language, visuals, and structure of TNOC supported knowledge transfer about thyroid nodules and their management options, helping them better understand their situation. Patients felt they worked together with their clinician by going through the conversation aid, making them feel comfortable asking questions. However, patients reported that the clinician's familiarity with TNOC and the learning needs of patients could affect the perceived benefit of the conversation aid. Patients suggested including more information and visuals in TNOC and providing access before/after the visit.
Interpretation: Patients found that the use of TNOC in medical encounters was helpful to understand information, treatment options, and working with their clinicians. This information supports the implementation of TNOC in practice to support decision-making.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.