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  • br Four team members R S S

    2019-11-11


    Four team members (R.S.S., N.P.C., C.L.M., and J.O.) thematically analyzed a subset of interview transcripts (n ¼ 8) to develop an initial coding framework.27 After the open coding process, trained study team members coded all tran-scripts using NVivo software (QSR International, Victoria, Australia). A constant comparative method allowed us to continuously integrate emerging themes into the codebook and recode previously coded transcripts. Themes and coding structures were compared and discrepancies were resolved by consensus. The overall intercoder reliability of the trained coders was excellent (kappa >0.77).
    After the open coding period, two members of the research team (S.C.P. and E.W.) analyzed codes related to (1) commu-nication, (2) barriers and facilitators of care, and (3) fear and anxiety to identify any patterns as part of the higher level analysis that aimed to characterize patients’ preoperative experience, focusing on their needs and values.27 Analysis continued until we reached saturation. The entire study team met regularly during this Imatinib (STI571) process to discuss the descriptive summaries and collaboratively develop a model that repre-sents the patient experience and needs. Throughout this manuscript, participants are referred to by number to demonstrate the range of responses. For example, participant 8 is referred to as P-8.
    Results
    Of the 38 patients with papillary thyroid cancer who con-sented to participate in the trial, 32 participated in a semi-structured interview before undergoing surgery and are included in this analysis. Five patients withdrew from the trial before completing an interview, and the Imatinib (STI571) audio-recording of one patient was unable to be transcribed and coded. These patients were seen by 7 surgeons. Table 1 presents the soci-odemographic characteristics of the participants. The main
    Table 1 e Participant demographics and clinical characteristics (n [ 32).
    Characteristic No. (%)
    Education
    Some college/associates degree graduates 9 (28)
    College graduate 9 (28)
    One or more chronic conditionsy 16 (52)
    Personal history of cancerz 5 (16)
    Family history of cancerz 23 (74)
    Incidentally discovered thyroid nodule 9 (29)
    * Four respondents did not provide the indicated information (n ¼ 28).
    y Two respondents did not provide the indicated information (n ¼ 30).
    z One respondent did not provide the indicated information (n ¼ 31).
    theme that emerged was the need for a strong relationship with their surgeon that provides reassurance. Three key, interrelated parts of a successful patient-surgeon relationship included (1) being provided adequate informational support,
    (2) receiving ample emotional support, and (3) being treated as an individual (Figure).
    Informational support
    Thyroid cancer patients in this study strongly desired infor-mational support from their surgeon at their initial consulta-tion (Table 1). Participants wanted details about multiple
    InformaƟonal
    EmoƟonal
    Treatment as an Support
    Support
    Individual
    Individualized ValidaƟon & empathy
    Respect
    Strong
    PaƟent-Surgeon RelaƟonship
    Trust
    Reassurance
    Fig e The central need of patients with thyroid cancer before surgery was a strong patient-surgeon relationship characterized by informational and emotional support as well as respect for them as an individual. Development of a strong relationship provided patients with a profound sense of reassurance and adequately prepared them for surgery. 
    aspects of their disease and treatment including their diag-nosis, prognosis, treatment options, details of the surgery, possible complications, the surgeon’s experience and complication rates, postoperative recovery, logistics related to their treatment and follow-up, and radioactive iodine (Table 2). Gaining knowledge from their surgeon about these aspects of the treatment continuum reassured and empow-ered participants, providing them with a greater sense of control. Participants also wanted their surgeon to provide in-formation that was individualized and specific to their case. This finding was particularly pronounced in patients whose job involved using their voice professionally. Participant 16 exemplified this need by describing: “[My voice] is my big concern. It’s almost more of a concern than the cancer itself. And they talked about finding the vocal cord and getting respiratory surface out of the way, so that was very reassuring. I felt instantly comfortable.”