Australian Decision Aid for low-risk Papillary Thyroid Cancer Impact on the use of a Decision Aid in Adult patients with Low Risk Thyroid cancer

To evaluate a hybrid (paper and web-based) decision aid for initial management of low-risk thyroid cancer (“the Decision Aid") within clinical practice, assessing its acceptability and effect on shared decision making including decisional conflict, regret, satisfaction. Thyroid cancer has very good outcomes and recent guidelines have suggested that patients can chose between active surveillance (no surgery by regular follow-up), hemithyroidectomy (removal of the half of the thyroid containing the cancer) or total thyroidectomy (removal of the whole thyroid). Prior research has identified a gap in information resources available to both clinicians and patients when making this decision. We have developed decision support tools to assist patients and clinicians in the process of shared decision making for low-risk thyroid cancer. We have collected patient and clinician feedback and developed a paper and web-based decision aid. Decision aids aim to enhance shared decision-making by improving information sharing and clinician-patient communication. Recognising that surgeons and patients have varied information needs and communication styles, a two-page paper aid and a detailed website were developed and revised over three years. The paper aid is meant for use during specialist consultations, tailored to each patient’s context, while the website allows patients to explore additional information at their own pace. The intervention in this study is both the paper and web based decision aids. The website can be found at: https://thyroidology.au/thyroid_aid/ During the one-on-one, face to face clinical encounter with the patients specialist, patients will be screened and recruited into the study by the specialist based on eligibility. This is potentially a single consultation. Patients choosing to participate will be sent an email that contains a link to study information and the first set of surveys. Participants that consent to this study will be asked to complete 6 x survey questionnaires at two timepoints: baseline and 8-months after consultation. Each survey contains between 5-30 questions. Completion of all surveys will take approximately 10-15 minutes. Adherence is monitored. Screened patient details will be entered into redcap within 24 hours of the consultation. Patients who have not responded to the initial patient survey within 24 hours will receive a reminder email regarding the survey. Those who have not responded within 72 hours will be sent a SMS and/or called. There are two phases to this study, the first, the preintervention phase, assesses patients baseline responses prior to the use of the decision aid in practice. During this phase, the decision aid materials will NOT be supplied. This phase is anticipated to take 3 months. Following this, there will be a “washout phase” where no recruitment will be undertaken. This will allow for clear delineation between the two phases of the study. The intervention phase will recruit the same target population and assess outcomes with the same surveys, allowing comparisons between the cohorts. During the intervention phase, clinicians and patients will have access to BOTH the paper decision aid materials and the web-based decision aid materials. The intervention phase is anticipated to take 6 months.