Grant Number:	5R03CA283105-02 Interpret this number
Primary Investigator:	Pitt, Susan
Organization:	University Of Michigan At Ann Arbor
Project Title:	A Pilot Feasibility Study of an Intervention to Decrease Overtreatment of Low-Risk Thyroid Cancer
Fiscal Year:	2024

PROJECT SUMMARY Nearly 90% of patients with low-risk papillary thyroid cancer undergo total thyroidectomy, the treatment option with the greatest morbidity, even though less invasive options offer equivalent recurrence and survival. Overtreatment of these patients results in significant patient harm and substantial costs. Currently, patients have unmet informational needs that contribute to the uptake of total thyroidectomy. Patients with low-risk papillary thyroid cancer would benefit from an intervention that meets their informational needs and increases their ability to participate in the decision-making process. This proposal is a key step to support our longer-term goal of reducing overtreatment of low-risk thyroid cancer by intervening on surgical decision making. Our research team developed a novel intervention called CQUPLE, which includes (1) a Chart of side-by-side, evidence-based information comparing all three management options for low-risk thyroid cancer, including expected outcomes and (2) a Question Prompt List that contains key questions to consider asking the surgeon. The intervention is grounded in social cognitive theory and aims to increase patient awareness of treatment options and their outcomes, patient activation, and self-efficacy for decision making. This proposal will pilot CQUPLE at three clinic sites in a single health system. We propose a pilot feasibility randomized controlled trial in 50 patients with low-risk papillary thyroid cancer to evaluate the feasibility and acceptability of CQUPLE (Aim 1) and characterize the distribution of outcomes (Aim 2). The results of the proposed research will provide the preliminary data necessary to prepare for a future, large- scale pragmatic efficacy trial to test the effect of CQUPLE on patients’ choice for total thyroidectomy. CQUPLE is a low-cost, scalable, patient-directed intervention that is innovative because it combines two complimentary components that work to meet patients’ informational and decisional needs through different mechanisms. The research is significant because reducing rates of total thyroidectomy for patients with low-risk thyroid cancer has the potential to decrease patient harm and improve long-term outcomes. Our multidisciplinary team’s history of successful collaboration and experience in behavioral intervention design and testing with randomizes controlled trials make us well positioned to achieve the aims of this award.




Approach to the patient with low-risk thyroid cancer.
Authors: Pitt S.C. , Haymart M.R. .
Source: The Journal Of Clinical Endocrinology And Metabolism, 2026-09-16 00:00:00.0; 111(10), p. 2960-2968.
PMID: 42338425
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Communication of Cost in Thyroidectomy: A Mixed-Methods Analysis of Financial Toxicity.
Authors: Kao D.D. , Crowley E.V. , Jensen C.B. , Bacon E.M. , Bradley S.E. , Thomas J.D. , Pitt S.C. .
Source: Otolaryngology--head And Neck Surgery : Official Journal Of American Academy Of Otolaryngology-head And Neck Surgery, 2026 Jun; 174(6), p. 1457-1467.
EPub date: 2026-04-06 00:00:00.0.
PMID: 41940688
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A missed opportunity to discuss treatment costs? A qualitative analysis of preoperative conversations about thyroid cancer treatment.
Authors: Crowley E.V. , Jensen C.B. , Bacon E.M. , James B.C. , Pitt S.C. .
Source: Surgery, 2026 Apr; 192, p. 110075.
EPub date: 2026-01-29 00:00:00.0.
PMID: 41616744
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Thyroid Cancer-Specific Worry in the United States: A Survey.
Authors: Evans E.E. , Jensen C.B. , Chiu A.S. , Hoxha I. , Saucke M.C. , Pitt S.C. .
Source: Annals Of Surgical Oncology, 2025-06-16 00:00:00.0; , .
EPub date: 2025-06-16 00:00:00.0.
PMID: 40522575
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Communication of Voice-Related Complications in Thyroidectomy: A Qualitative Analysis.
Authors: Kao D.D. , Jensen C.B. , Bacon E. , Hogikyan N.D. , Roman B.R. , Pitt S.C. .
Source: Otolaryngology--head And Neck Surgery : Official Journal Of American Academy Of Otolaryngology-head And Neck Surgery, 2025 May; 172(5), p. 1560-1569.
EPub date: 2025-02-18 00:00:00.0.
PMID: 39963871
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The Effect of a Surgeon Communication Strategy on Treatment Preference for Thyroid Cancer: A Randomized Trial.
Authors: Jensen C.B. , Sinco B. , Saucke M.C. , Bushaw K.J. , Antunez A.G. , Voils C.I. , Pitt S.C. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2025 May; 45(4), p. 426-436.
EPub date: 2025-03-27 00:00:00.0.
PMID: 40145501
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The Fear Factor: How Cancer Recurrence Shapes Treatment Choices About Thyroid Cancer.
Authors: Jensen C.B. , Pitt S.C. .
Source: World Journal Of Surgery, 2025-04-09 00:00:00.0; , .
EPub date: 2025-04-09 00:00:00.0.
PMID: 40204684
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Trends in incidence, metastasis, and mortality from thyroid cancer in the USA from 1975 to 2019: a population-based study of age, period, and cohort effects.
Authors: Chen M.M. , Luu M. , Sacks W.L. , Orloff L. , Wallner L.P. , Clair J.M. , Pitt S.C. , Ho A.S. , Zumsteg Z.S. .
Source: The Lancet. Diabetes & Endocrinology, 2025 Mar; 13(3), p. 188-195.
EPub date: 2025-02-05 00:00:00.0.
PMID: 39922210
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Developing a large-scale quality improvement program for thyroid cancer surgery.
Authors: Jensen C.B. , Bacon E.M. , Krumeich L.N. , Underwood H.J. , Hughes D.T. , Gauger P.G. , Burney R. , Pitt S.C. .
Source: World Journal Of Surgery, 2024-10-15 00:00:00.0; , .
EPub date: 2024-10-15 00:00:00.0.
PMID: 39404618
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Surgeon Preference for Maximizing Medical Care Is Associated with Recommending More Extensive Surgery for Low-Risk Thyroid Cancer.
Authors: Antunez A.G. , Saucke M.C. , Bushaw K.J. , Chiu A. , Pitt S.C. .
Source: Thyroid : Official Journal Of The American Thyroid Association, 2024 Sep; 34(9), p. 1181-1185.
EPub date: 2024-07-31 00:00:00.0.
PMID: 39030827
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Surgeon Preference for Maximizing Medical Care Is Associated with Recommending More Extensive Surgery for Low-Risk Thyroid Cancer.
Authors: Antunez A.G. , Saucke M.C. , Bushaw K.J. , Chiu A. , Pitt S.C. .
Source: Thyroid : Official Journal Of The American Thyroid Association, 2024 Sep; 34(9), p. 1181-1185.
EPub date: 2024-07-31 00:00:00.0.
PMID: 39030827
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Making Choices: A Multi-institutional, Longitudinal Cohort Study Assessing Changes in Treatment Outcome Valuation for Low-Risk Thyroid Cancer.
Authors: Antunez A.G. , Sinco B.R. , Saucke M.C. , Bushaw K.J. , Jensen C.B. , Dream S. , Fingeret A.L. , Livhits M.J. , Mathur A. , McDow A. , et al. .
Source: Annals Of Surgery, 2024-05-20 00:00:00.0; , .
EPub date: 2024-05-20 00:00:00.0.
PMID: 38766877
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Health-Related Quality of Life in Patients with Low-Risk Differentiated Thyroid Cancer: A Systematic Review Examining the Extent of Thyroidectomy.
Authors: Bach K. , Ansari P. , Ansari H. , Mott N.M. , Elfenbein D.M. , Underwood H. , Pitt S.C. .
Source: Thyroid : Official Journal Of The American Thyroid Association, 2024 Jan; 34(1), p. 14-25.
EPub date: 2023-11-14 00:00:00.0.
PMID: 37861284
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