Thyroid cancer patients' involvement in adjuvant radioactive iodine treatment decision-making and decision regret: an exploratory study.

PURPOSE: We explored regret in thyroid cancer patients, relating to the decision to accept or reject adjuvant radioactive iodine treatment. METHODS: We studied patients with a recent diagnosis of early stage papillary thyroid carcinoma, in whom treatment decisions on adjuvant radioactive iodine had been finalized. Participants completed a Decision Regret Scale questionnaire. We asked the participants to identify who made the final decision about radioactive iodine treatment. We explored the relationship between decision regret and a) degree of patient involvement in decision-making and b) receipt of radioactive iodine treatment. RESULTS: We included 44 individuals, more than half of whom received adjuvant radioactive iodine treatment (26/44). Decision regret was generally low (mean 22.1, standard deviation [SD] 13.0). Participants reported that the final treatment decision was made by the following: patient and doctor (52.3%, 23/44), completely the patient (27.3%, 12/44), or completely the physician (20.5%, 9/44). Decision regret significantly differed according to who made the final decision: the patient (mean 19.0, SD 11.3), patient and doctor (mean 19.5, SD 7.4), and the doctor (mean 32.9, SD 20.37) (F = 4.569; degrees of freedom = 2, 41; p = 0.016). There was no significant difference in decision regret between patients who received radioactive iodine and those who did not (mean difference -2.5; 95% confidence interval -10.6, 5.6; p = 0.540). CONCLUSION: Thyroid cancer patients who reported being involved in the final treatment decision on adjuvant radioactive iodine had less regret than those who did not.

How can we meet the information needs of patients with early stage papillary thyroid cancer considering radioactive iodine remnant ablation?

In patients with early stage papillary thyroid carcinoma (PTC) who have had a thyroidectomy, the decision must be made to accept or reject radioactive iodine remnant ablation (RRA). Counselling patients about this decision can be challenging, given the medical evidence uncertainties and the complexity of related information. Although physicians are the primary source of medical information for patients considering RRA, some patients have a desire for supplemental information from sources such as the internet. Yet, thyroid cancer resources on the internet are of variable quality, and some may not be applicable to the individual case. We have developed a computerized educational tool [called a decision aid (DA)], directed to patients with early stage papillary thyroid cancer, and intended as an adjunct to physician counselling, to relay evidence-based medical information on disease prognosis and the choice to accept or reject RRA. DAs are tools used to inform patients about available treatment options and have been utilized in oncologic decision-making. We tested our web-based DA in fifty patients with early stage PTC and found that it improved medical knowledge. Furthermore, participants found the technical usability of the tool acceptable. We are currently conducting a randomized controlled trial comparing the use of the DA plus usual care to usual care alone to confirm the educational benefit of the website and examine its impact on the decision-making process. In the future, DAs may play an expanded role as an adjunct to physician counselling in the care of patients with thyroid cancer.

Quantitative tests for psoralens in the blood: methods and uses in monitoring psoralen and longwave radiation therapy.

Variability in 2 factors determines the therapeutic success of photochemotherapy with psoralens and UV radiation at 320-400 nm (PUVA): biochemical properties of the photosensitizing drug used and characteristics of the source of irradiation. Fine-tuning of PUVA therapy is achieved by delivery to the patient of the phototoxic dose of UV radiation at the precise time of peak bioavailability of the photosensitizing psoralen; thus it depends on accurate means for measuring the 2 variables. The UV emission is easily measured, but bioavailability of photosensitizing drugs is not. Blood levels provide information about the photosensitivity of the patient and thus relate to therapeutic efficacy. The oral dose of 8-methoxypsoralen (8-MOP) cannot be used to predict what plasma levels of the drug will be achieved. Dissolution and absorption of 8-MOP are affected by the form of the preparation. Absorption rates vary far more than do elimination rates in the same population of patients, but individual differences in metabolism of the drug have not been documented. Maximum therapeutic benefit varies from individual to individual. It may be influenced by factors affecting absorption, distribution, and metabolism of the drug and by skin type and degree of skin pigmentation.

A test-retest reliability study on clinical measurement of masking level differences.

Measurement of binaural release from masking was studied in 30 normal and 10 hearing-impaired subjects to determine the test-retest reliability of masking level differences measured with a clinically feasible technique on generally available clinical equipment. The instrumentation/methodology was found to elicit reliable, consistent, rapid measurements for both 500-Hz and speech (spondaic) stimuli which were comparable with those generally reported in the literature as laboratory-conducted experiments.

Masking level difference: a measure of auditory processing capability.

MLDs are evidence of the superiority of the binaural auditory system. Cochlear lesions do not necessarily impair the MLD and persons with cortical lesions are also able to produce normal MLDs. The evidence for intermediate level auditory pathway lesions is more equivocal. The MLD is not the only measure of binaural hearing and binaural hearing is itself only one measure of a number of complex auditory processes. In this experiment measures of MLDs, localization, temporal integration, central masking and difference limen for intensity were made on 11 persons with normal hearing. Correlational analyses including factor analysis indicated that the MLD is a fairly independent measure but that central masking, brief tone audiometry and difference limen for intensity represent related auditory tasks. The relationship of localization tasks in this picture is unclear.