Optimization of Thyroid Nodule Care Delivery to Reduce the Burden of Thyroid Cancer

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Linked publications, trials & patents

Abstract

Thyroid cancer is the most common endocrine malignancy in the United States (US), with an estimated 44,000 new cases anticipated in 2025. Over the past 40 years, its incidence has increased significantly, largely due to the overdiagnosis of small indolent papillary thyroid cancers. This trend has been driven by the widespread and sometimes inappropriate use of imaging studies, including thyroid and neck ultrasonography. Approximately 60% of US adults have thyroid nodules, and the evaluation and treatment process can lead to psychological distress and sleep disturbances due to concerns about potential cancer risk. There is a lack of granular data on thyroid nodule care delivery in real-world clinical settings, particularly in the context of recent medical and technological advances. Since 2020, many hospitals have incorporated telehealth services, including virtual care visits and secure messaging, into their healthcare delivery models. However, the use of telemedicine for thyroid nodule care has not yet been comprehensively explored. Additionally, over the last three years, non-surgical, minimally invasive management options such as radiofrequency ablation have become more widely available for the treatment of benign thyroid nodules in the US. However, there is a lack of granular data on the real-world use of these novel treatment options. To optimize thyroid nodule care and ultimately mitigate the burden of thyroid cancer overdiagnosis, we propose developing a thyroid nodule decision preparation tool to support patients in communicating with their physicians and in the decision-making process. This tool will be informed by data from physician surveys and patient focus groups. In Aim 1, we will survey a national sample of primary care physicians and endocrinologists to examine variation in thyroid nodule care delivery. In Aim 2, we will recruit patients with thyroid nodules from two sites, the University of Michigan (U-M) and the University of California, San Francisco (UCSF), to conduct virtual focus groups to explore their experiences with thyroid nodule evaluation and treatment. In Aim 3, we will use study findings from Aims 1 and 2 to inform the development and evaluation of a thyroid nodule decision preparation tool prototype for patients. Data from the subsequent pilot clinical trial to evaluate the feasibility, acceptability, and preliminary effectiveness of this intervention will inform a R01 application to develop and evaluate a more comprehensive, multilevel, personalized thyroid nodule decision preparation tool. This innovative research proposal addresses a critically important public health need while serving as a vehicle for Dr. Debbie Chen’s development into an independent health services researcher in the fields of cancer care delivery and thyroidology. In addition to didactic learning, she will receive mentoring from her team of committed mentors and advisors who have complementary expertise and are internationally recognized experts in their field. Upon completion of this carefully designed project linking skill acquisition to research aims, Dr. Chen will emerge as an expert in thyroid cancer care delivery.