A Mixed Methods Evaluation of a Computerized Decision Aid for Patients Considering Radioactive Iodine RemnantAblation: developing person-centered medicine for thyroid cancer.

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Anna M. Sawka
Soumia Meiyappan
Dana David
Sharon E. Straus
Amiram Gafni
James D. Brierley
Richard W. Tsang
Gary Rodin
Lorne Rotstein
Shereen Ezzat
David P. Goldstein


Background and Objective:  Patients with early stage papillary thyroid cancer (PTC) who have had a thyroidectomy are often faced with the decision to accept or reject adjuvant radioactive iodine (RAI) treatment (remnant ablation).  We have designed a patient-directed computerized decision aid, intended to educate patients about this choice as a contribution to the development of person-centered medicine.  The objective of this study was to test the usability of this decision aid in patients with a recent diagnosis of early stage PTC, using a mixed methods approach.Methods: The decision aid was tested by individuals with early stage PTC (4 cm or smaller primary tumor with no known lymph node nor distant metastases), who had recently undergone thyroidectomy.  After using the decision aid, the participants were interviewed, using semi-structured questions.  Qualitative participant feedback was obtained, major themes were categorized and quantified.Results:  The decision aid was tested by 50 participants; all 97 comments on the usability and all 67 comments on the credibility of the decision aid, were positive.  There were 37 positive comments on the understandability of the decision aid, 8 neutral ones and no negative ones.   Participants’ opinions on the relevance of the medical content were categorized as follows: 52 positive, 2 neutral and 1 negative.  Furthermore, general comments about the decision aid were categorized as follows:  75 positive, 11 neutral and 8 negative.Conclusions:  A patient-directed computerized decision aid explaining the choice of radioactive iodine remnant ablation compared to no remnant ablation, was received with largely positive feedback from individuals with a recent diagnosis of PTC. We advance our study as an important contribution to person-centered medicine for the patient with thyroid malignancy.

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