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  • br Our results indicate that another area that warrants

    2019-11-11


    Our results indicate that another area that warrants attention and can be improved is informational support in the preoperative period. We show that when patients’ in-formation needs are satisfied, they feel reassured and confident. Patients also prefer the surgeon to be the primary source of information and want ample time to ask ques-tions. This finding is consistent with Sawka et al. who revealed that physician counseling was the most important information source for patients with thyroid cancer post-operatively when discussing radioactive iodine.37 Studies of thyroid and other cancer survivors similarly show that being able to ask questions is crucial, but often is not
    possible due to time constraints. Ensuring that the
    information is individualized was a strong preference of our study participants which has also been shown in those with other cancers.40 Strategies to fill these information gaps include improving information materials, which may require including stakeholders in the design. Surgeons can also learn to better assess patients’ informational needs and Malonyl Coenzyme A of information seeking, which may not be overt, but hidden in statements about emotional concerns, such as “I am worried about the cancer spreading.”41 Additional research needs to identify the optimal content, context, and timing of information provision to be maximally effective keeping in mind that patients’ preferences for information differ.31 A multimodality, team approach to meeting pa-tients’ needs may enhance the experience of these and other patients.
    Emotional support is the other key area that we identified as critical for patients with thyroid cancer in the preoperative period. Data in thyroid and other cancer survivors demon-strate that psychosocial and emotional support needs are often not met preoperatively.12,22-26 In addition, a lack of emotional support can result in erosion of trust in the physi-cian, increased psychological distress, poor decision-making, dissatisfaction, and decreased quality of life.31,35,42,43 Research shows that physicians who express a higher level of empathy have a more accurate understanding of cancer patients’ unmet needs. This empathy also provides reassur-ance and nonabandonment when breaking bad news, de-creases physiologic arousal, and improves both information recall and long-term satisfaction.28,44-48 Our results and those of others suggest that clinician can learn behaviors that improve this emotional support, such as eliciting and vali-dating patients’ emotions, offering encouragement, avoiding interruptions, and allowing time for patients to discuss ex-pectations and voice concerns.31 These actions improve emotional support and are critical to building trust within the patient-surgeon relationship. Our data suggest this emotional support should also be individualized, and for those patients with thyroid cancer, the “good cancer” terminology should be avoided.49-51
    Although we identified several areas where we can improve the preoperative experience of patients with thyroid and likely other cancers, our study also has limitations. This investigation was performed at a single institution where the patient population is predominantly white and well educated, which may influence their needs and values. Patients with thyroid cancer in other cultural or geographical settings may have needs that we did not identify. Our study also did not include patients with microcarcinomas ( 1 cm thyroid can-cers), indeterminate nodules, more advanced disease, or other types of thyroid cancer. These populations may have different reactions to their diagnosis or different cancer experiences. Therefore, further analysis is needed to determine if our findings are valid in these patient groups. Despite these weaknesses, similar prospective qualitative data in this or similar patient populations do not exist.