Active surveillance for thyroid Cancer: a qualitative study of barriers and facilitators to implementation

Abstract Background The 2015 American Thyroid Association guidelines supported active surveillance (AS) as a strategy for managing select low-risk thyroid cancers. Data examining physicians’ attitudes about the acceptability of this option are limited. This study aimed to characterize barriers and facilitators implementing AS perceived by practicing endocrinologists surgeons in United States. Methods We conducted 24 semi-structured interviews probing toward patients with small, cancer. used deductive content analysis guided well-known model guideline implementation. Analysis characterized concepts themes related implementation physician, guideline, or external factors. performed member checking validate results. Results most prominent were physician factors, although guideline-specific also observed. Physician towards comprised majority physician-related barriers, while lack knowledge was discussed. Participants’ concerns potential negative outcomes resulting from observing cancer notable confidence performing offering surveillance. Beliefs patient expectations identified Guideline-specific included vagueness protocols, data supporting surveillance, societal beliefs Facilitators patients’ desire avoid surgery shared decision-making. Conclusions Barriers cancers exist at multiple levels. Strategies increase adoption should focus on attitudes, expectations, outcomes, promoting societal-level acceptance