AT ENDO 2015

San Diego (FRONTLINE MEDICAL NEWS) – Graves’ disease patients are more comfortable with their treatment decisions when doctors walk them through the options with a short pamphlet being developed at the Mayo Clinic in Rochester, Minn.

None of the three treatment options for Graves’ – thyroidectomy, radioactive iodine, and antithyroid drugs – is clearly superior to the others. That usually means that patients end up getting whatever treatment their institution prefers, and not so much making the choice themselves, said lead investigator Dr. Juan Brito, an assistant endocrinology professor at the Mayo Clinic.

That approach isn’t going to work much longer as patient involvement and satisfaction come online as quality metrics, Dr. Brito noted.

Shared decision making has been a theme at Mayo for a while now, he said, and the institution has developed and validated a range of “decision-making tools” for patients with various diseases. The Graves’ disease pamphlet is among its latest efforts.

“We don’t really care if patients make a decision for surgery, medicine, or radioactive iodine,” said Dr. Brito. “What we care about is that patients know what they are doing, are more involved in the process, and more satisfied with their decisions.

“We want patients to decide, not the institution,” added Dr. Brito, who noted that Mayo has traditionally been a radioactive iodine institution.

The Graves’ decision pamphlet lays out the pros and cons of all three options – effectiveness, costs, number of follow-up visits, likelihood of thyroid replacement, eye complications, and the like – using five easy-to-understand graphics. The goal is for doctors to use the pamphlet during consultations to ensure that all the bases are covered and patients understand what they hear. The pamphlet doesn’t make consults longer, Dr. Brito noted – if anything, it shortens them a bit.

To assess the pamphlet’s effectiveness, Dr. Brito and his team surveyed patients after their encounters.

The 19 patients guided through their options with the “Graves’ Disease Treatment Choice” pamphlet were more involved with decisions than the 33 patients who were not, as measured by the OPTION [observing patient involvement in decision making] scale (mean score 38.5 points versus 30.8, with 100 points indicating the greatest involvement, P = 0.02).

Pamphlet patients also were more certain of their decisions, as assessed by the Decisional Conflict Scale (19 points versus 31 points, with 0 points being complete certainty, P = 0.19). The length of the discussion was slightly shorter with the pamphlet (37 minutes versus 39 minutes), but the difference was not significant.

Pamphlet patients also seemed more knowledgeable about treatment side effects, and were more likely to choose radioactive iodine and less likely to choose antithyroid drugs; but the differences in what they opted for were also not significant.

On average, patients were in their early 40s, and three-quarters were women.

The decision tool “improves patient involvement in decision making about treatment options without increasing the length of the consultation,” Dr. Brito explained. “This tool helps the patient and clinician navigate through the options and enhances the quality of the process.”

The investigators have no disclosures and no outside funding for their work.