Up to one-third of physicians reported sending sufferers for a thyroid ultrasound for reasons not supported by medical care tips, a brand new examine led by University of Michigan Rogel Cancer Center researchers finds.
Routine use of ultrasounds to detect cancerous thyroid nodules have led to a major enhance in thyroid most cancers instances in recent times, though many are low-risk and unlikely to trigger critical hurt.
Researchers surveyed 610 surgeons, endocrinologists and primary care physicians who had been concerned in thyroid most cancers care. Physicians got totally different affected person eventualities and requested after they would schedule a thyroid or neck ultrasound.
An overwhelming majority of physicians stated they used ultrasound for reasons that are supported by medical care tips, corresponding to a big nodule that may be felt or one seen on one other imaging check. But 33% stated they ordered an ultrasound as a result of the affected person wished it and 28% stated irregular thyroid perform tests drove their choice—an element the Choosing Wisely Campaign particularly advises towards.
Results are revealed in JAMA Surgery.
“This study is the first to look at why physicians are using thyroid ultrasound for patients. While often it’s for clinically relevant reasons, a substantial number of physicians are not ordering them for reasons that are clinically supported,” says senior examine writer Megan R. Haymart, M.D., Nancy Wigginton Endocrinology Research Professor of Thyroid Cancer and professor of inner medication at Michigan Medicine.
When requested what most affected their choices for sufferers with thyroid nodules, 69% cited current medical tips. Haymart says this exhibits the state of affairs is malleable.
“We can change behavior and help physicians use thyroid ultrasound more appropriately, which will reduce the incidence of low-risk thyroid cancer,” she says.
Organizations such because the National Comprehensive Cancer Network and the American Thyroid Association provide care tips based mostly on information and outcomes from revealed research. In addition, the Choosing Wisely marketing campaign, which launched in 2012, identifies tests and procedures that must be mentioned between sufferers and physicians to make sure applicable and crucial remedy.
“There is not specifically a guideline for when to order a thyroid ultrasound. The guidelines start once you find a nodule,” says examine first writer Debbie W. Chen, M.D., an endocrinology fellow at Michigan Medicine. “Our study suggests there is an opportunity when working on the next set of guidelines to look a little upstream, before a clinical diagnosis, and offer better guidance for when thyroid ultrasound is necessary.”
The key, researchers say, is to establish these thyroid cancers that can require remedy however to keep away from overdiagnosis by discovering nodules that are slow-growing and will by no means want remedy.
The discovering that physicians had been ordering thyroid ultrasounds as a result of sufferers requested for them suggests a necessity for extra schooling and dialogue, Haymart says.
“There’s so much emphasis in medicine on patient satisfaction. You do want patients to be satisfied, but physicians also have to do what’s medically appropriate,” she says. “Developing decision aids could help patients understand and decide when thyroid ultrasound is appropriate and when it’s not.”
JAMA Surgery (2020). DOI: 10.1001/jamasurg.2020.2507
University of Michigan
Some physicians are ordering thyroid tests for unsupported reasons (2020, August 12)
retrieved 12 August 2020
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