PSAT245 Feasibility of introducing a conversation aid for patients with thyroid nodules in clinical practice: Understanding the clinician experience
Authors: Chavez Chandani Patel , Hartasanchez Sandra , Hidalgo Jessica , Leiva Eddison Godinez , Bagautdinova Diliara , Regina Castro M , Dean Diana , Morris John C , Ryder Mabel , Stan Marius , Barb Diana , Danan Deepa , Dziegielewski Peter , Edwards Catherine M , Hughley Brian , Srihari Ashok , Subbarayan Sreevidya , Hargraves Ian G , Shepel Kathryn , Brito Campana Juan P , Carma Bylund , Treise Debbie , Montori Victor , Ospina Naykky Singh 
Published: November 2022

Abstract

Background
To support the collaboration between patients with thyroid nodules and their clinician, we developed a Thyroid NOdule conversation aid (TNOC). TNOC includes a representation of thyroid cancer risk, alternative management options, and a print-out summary for patients. In a pilot study, the use of TNOC was associated with improvement in the quality of diagnostic conversations.
Research question: The aim of this study was to evaluate the feasibility of introducing TNOC into clinical encounters and understand clinicians’ experience with its use.

Methods
Prospective study conducted in two academic centers in the U.S. We included adult patients with thyroid nodules and their clinicians (endocrinologists and ear, nose, and throat specialists (ENT)). The feasibility of introducing TNOC was evaluated by the fidelity to which TNOC was used (12 item checklist of included components, such as: thyroid cancer risk presentation, management options) and the duration of clinical visits, evaluated through video recordings. Clinicians completed a post-visit survey to evaluate how helpful and easy to use TNOC was and the degree to which it supported collaboration with their patients. A qualitative analysis of semi-structured interviews was conducted after clinicians used TNOC in at least three visits. The interview guide was developed following constructs included in the Consolidated Framework for Implementation Research. Analysis was conducted using the constant comparative method.

Results
Twelve clinicians (9 endocrinologists and 3 ENT) were included and used TNOC with 53 patients. Most patients were women (N -42, 79%) 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). The median clinical visit duration was 17 minutes (Interquartile range 10,28). The median fidelity score was 75% (interquartile range 58, 75), with thyroid cancer risk presentation being the most commonly used item (98%) and the printable summary the least used (15%). Clinicians agreed or strongly agreed that TNOC was helpful (N=34, 65%), easy to use (N=44, 85%), and supported collaboration with patients (N= 32, 62%).
In the qualitative analysis, clinicians reported that TNOC was organized and covered commonly discussed topics. Moreover, the use of TNOC could support the clinical interaction and be beneficial for patients by assuring the patient perspective was considered, creating space for questions, and improving how information was presented. Yet, the perceived benefit of using TNOC was expected to be different depending on the expertise of the clinician, as experts might benefit less. Clinicians highlighted the importance of familiarity with TNOC to ease its use and suggested modifications: additional visual content, improved navigation to support dynamic use and providing patient access before/after the visit.
Interpretation: Using TNOC to support thyroid nodule management conversations was feasible, helpful, easy to use, and supportive of patient-clinician collaboration.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.