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Through a pilot randomized controlled trial (RCT), we aim to test the feasibility and preliminary impact of two online educational resources among adult patients with thyroid cancer. Each online program can be accessed on the patient's personal device, and will be provided to the patient following a diagnosis of thyroid cancer but before meeting with their surgeon to discuss treatment options. The goal of the resource is to educate patients on the various treatment options for thyroid cancer prior to surgical consultation, so that clinic visit time can be better utilized to discuss patient questions and priorities, and support shared decision making. Clinical (TC-MAX; thyroid cancer related anxiety) and behavioral outcomes (decisional conflict, shared-decision making, treatment decision) will be assessed via online surveys 1-day and 14-days post-visit.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| THRIVE | Experimental | Participants randomized to the THRIVE arm will be sent a link to access the THRIVE portal up to 3 weeks prior to their clinic visit. The THRIVE modules can take between 20-35 minutes to complete. Completion of the THRIVE modules prior to the clinic visit will be monitored and confirmed by study staff. Upon completing the program, a report summarizing the conversation and questions/comments brought up by the patient will be shared with their physician prior to the clinic visit. |
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| Education Control | Sham Comparator | Participants randomized to the education control arm will be sent a link to access the 2-page American Cancer Society (ACS) handout: "After a Thyroid Cancer Diagnosis." The handout can take between 5-15 minutes to read through. Completion of the ACS handout prior to the clinic visit will be monitored and confirmed by study staff. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| THRIVE | Behavioral | THRIVE is a tailored AI agent that provides patient education and assists in decision-making specifically for thyroid cancer patients. Using HIPAA-compliant protocols and an empathic approach, THRIVE can (1) establish patient priorities, (2) guide patients through decision tools, and (3) integrate detailed notes into the electronic health record (EHR). Such computer-generated notes have been found to be higher quality, more comprehensive, better organized, and with greater relevance compared with physician-documented notes. Altogether, this solution tackles a time-intensive and laborious task, expanding time and bandwidth for decision-making. Moreover, integration with existing infrastructure like the EHR can help promote clinical adoption. |
| Measure | Description | Time Frame |
|---|---|---|
| TC-MAX | Thyroid cancer-related anxiety as measured by the 18-item TC-MAX questionnaire created by Dr. Allen Ho at Cedars-Sinai. It is a psychometric scale assessing thyroid cancer-related anxiety across three different subscales (Collective Anxiety, Ultrasound Anxiety, and Fear of Recurrence/Progression). Scale range is between 0-100, with higher scores indicating greater anxiety. Means and standard deviations will be used to describe the scores. | Baseline, 1-day post clinic visit, 14-days post clinic visit |
| Measure | Description | Time Frame |
|---|---|---|
| Decisional Conflict Scale | Decisional conflict as measured by the 16-item Traditional Decisional Conflict Scale (DCS) - Statement Format. This scale assesses personal perceptions of uncertainty in choosing options; modifiable factors contributing to uncertainty such as feeling uninformed, unclear about personal values and unsupported in decision making; and effective decision making such as feeling the choice is informed, values-based, likely to be implemented and expressing satisfaction with the choice. This questionnaire uses a 5-point Likert scale, from strongly agree to strongly disagree. |
| Measure | Description | Time Frame |
|---|---|---|
| System Usability Scale | System usability as measured by the validated, 10-item System Usability Scale (SUS). This attitude Likert scale gives a global assessment of usability. Each item is rated on a scale of 0 to 5, with higher scores indicating greater usability. | 1-day post clinic visit |
Inclusion Criteria:
Newly diagnosed with either:
Able to understand and complete questionnaires independently in English
Access to an internet-enabled device for online surveys and intervention access
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Zoe Krut, MSHS | Contact | 310-423-0699 | Zoe.Krut@cshs.org | |
| Michael Fine, MSHS | Contact | michael.fine@cshs.org |
| Name | Affiliation | Role |
|---|---|---|
| Allen Ho, MD | Cedars-Sinai Medical Center | Principal Investigator |
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| ID | Term |
|---|---|
| D013964 | Thyroid Neoplasms |
| ID | Term |
|---|---|
| D004701 | Endocrine Gland Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D006258 | Head and Neck Neoplasms |
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| ID | Term |
|---|---|
| D009538 | Nicotine |
| ID | Term |
|---|---|
| D012991 | Solanaceous Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D011725 | Pyridines |
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|
| ACS "After a Thyroid Cancer Diagnosis" Flyer | Other | The 2-page American Cancer Society (ACS) flyer (No. 0827.60 Rev. 3/25) is titled "After a Thyroid Cancer Diagnosis" and provides brief information about "Treatment for thyroid cancer", "What to expect before and during treatment", "What to expect after treatment", "Staying healthy", and "Dealing with your feelings", as well as recommendations on questions to ask a physician for each of the above topics. The flyer also provides the patient with a link to the ACS website and a direct phone number. |
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| 1-day post clinic visit |
| Shared Decision Making | Patient perception of shared decision making as measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9). This questionnaire measures the extent to which patients are involved in the process of decision-making from the perspective of the patient. This questionnaire uses a 6-point Likert scale, from completely agree to completely disagree. | 1-day post clinic visit |
| D004700 |
| Endocrine System Diseases |
| D013959 | Thyroid Diseases |
| D006573 |
| Heterocyclic Compounds, 1-Ring |