A narrative review of decision aids for low-risk thyroid cancer

Background and Objective: The modern management paradigm underlying low-risk thyroid cancer has evolved considerably across the spectrum of diagnosis, treatment, and surveillance. The indolent nature of most thyroid cancers is increasingly recognized as the primary driver shifting focus to approaches that emphasize quality of life consequences, in contrast to potential overtreatment. Unsurprisingly, controversies persist in areas of treatment equivalence. Management now represents a complex interaction of patient preferences, physician biases, and transparent communication that satisfies stakeholder priorities without violating oncologic principles or standards of care. Shared decision making (SDM) through the use of decision aids is an emerging, potentially valuable means to bridge these factors by individually tailoring extent of surgery based on individual priorities. Methods: A literature search was performed using PubMed, SCOPUS, and Google Scholar to identify all original articles published in the English language from April 1, 1992 to April 1, 2022 that evaluated tools and aids for decision-making for thyroid cancer patients. Key Content and Findings: SDM is ideal in situations where the best option is unclear, the decision is sensitive to preference, and the outcome has consequence. In turn, decision aids across disciplines have been shown to reduce decisional conflict, decrease decisional regret, and enhance satisfaction with choices. While decision tools do not consistently change decisions, they do appear to engender more accurate risk perceptions and choices congruent with patient values. For thyroid cancer, conversation aids and question prompt lists currently guide clinic conversations, but no interactive decision aid methodologies exist. The comparative format of conjoint analysis may be most feasible for individualized thyroid cancer decisionmaking. Conclusions: Decision aid tools represent an understudied, high-value area of investigation for decisionmaking in thyroid cancer. Future directions entail incorporating techniques such as conjoint analysis into judicious, effective decision aids tailored to thyroid cancer patients.