Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey.

Context Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States. Objective To understand factors associated with adoption of AS. Design/setting/participants We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for two hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Main outcome measure Adoption of AS (non-adopters vs adopters, who respectively did not recommend or recommended AS at least once; partial vs full adopters, who respectively recommended AS for one or both cases). Results The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Non-adopters (45.7%) were significantly (p 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (p=0.04), know how to determine a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Non-adopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (p=0.03) and more likely to be anxious (p=0.04), have reservations (p=0.03), and have concerns about the psychological burden (p=0.009) of AS. Few respondents (3.2%) believed patients were aware of AS. Conclusions Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.