Australian Community Juries Address Overtreatment of Low-Risk Papillary Thyroid Cancer
Posted: Wednesday, January 27, 2021
A study published in the journal Thyroid examined the influence of disease terminology on the overtreatment of small low-risk papillary thyroid cancer. Some researchers propose that the term “cancer” may not reflect the indolent nature of the disease, whereas others argue that, pathologically, “cancer” is an accurate biologic representation of these tumors. The study evaluated the wider community’s perspectives on the effects of changing clinical terminology.
“Regardless of action on terminology, jurors shared a strong expectation that practical changes would be made to respond to the harms of overtreatment,” Stacy M. Carter, PhD, of the University of Wollongong, Australia, and colleagues reported.
The research team recruited 40 people to serve on 3 different community juries. The juries were held in Sydney, Wodonga, and Cairns, Australia. Diverse participants were randomly selected from the public. The juries were educated on thyroid cancer, overdiagnosis, and overtreatment. They were presented with arguments for and against the terminology change before deliberation.
Jury 1 favored no change in terminology compared with Juries 2 and 3, who were divided on the topic. The primary reasons for opposing the terminology change included a strong desire to retain terminology that aligns with disease pathology and to avoid any risk that could arise if patients became complacent in follow-up. Participants who supported terminology change reasoned that it may be a more effective trigger for health-system reform than other options. All three juries agreed that community education and health-system reforms were necessary to reduce the negative effects of overtreatment. The participants expressed an expectation of clinicians and researchers to agree on clinical guidelines that would more effectively promote active surveillance.
“The breadth of perspectives elicited in community juries signifies the importance of engaging the public in developing potential solutions for challenging health-care issues,” the researchers concluded.
Disclosure: The study authors reported no conflicts of interest.