Trade-offs between disease label and treatment options: The case of low risk papillary thyroid cancer.

Abstract

To evaluate the impact of disease nomenclature on patient preferences for treatment of low-risk papillary thyroid cancer (PTC) and explore the potential for reducing overtreatment by using less alarming terms in China. We conducted an online cross-sectional discrete choice experiment among 615 adults in China with a self-reported history of thyroid nodules or tumors. Hypothetical scenarios varied by disease label ("cancer", "tumor", "nodule"), management option (active surveillance vs surgery), risk of progression/recurrence requiring further treatment (0 %-5 %), and out-of-pocket cost (¥3000-¥15,000). Preferences were analyzed using a mixed logit model, and trade-offs were summarized using marginal rates of substitution (MRS). Participants showed a significant preference for less alarming terms like "tumor" or "nodule" over "cancer". The use of the term "cancer" significantly increased the likelihood of choosing aggressive treatments. The disease label was found to have a stronger influence on the preference for active surveillance than the actual risk of progression or recurrence. In China, preferences for low-risk PTC management are driven primarily by prognosis, with terminology also shaping choices beyond clinical risk. Using less alarming labels may support acceptance of conservative management when paired with clear risk communication. Practice implications Clinicians and guideline developers may consider standardized counseling that presents absolute risks clearly and uses careful, patient-centered terminology to facilitate shared decision-making and potentially reduce overtreatment.