Decision Regret in TIR3 Thyroid Surgery: A missing piece in patient-centered care?

Introduction: Given the diagnostic ambiguity and potential malignancy associated with indeterminate thyroid nodules(TIR3), patients face the dilemma of opting for diagnostic surgical intervention or engaging in active surveillance. Molecular assays assist in the stratification of risk; however, they do not yield a conclusive diagnosis. Considering the concept of decision regret in advance could be a valuable approach to increasing patients’ awareness and supporting more informed decision-making before a choice is made. Objective: This study was designed to evaluate the reliability and validity of the Italian version of the decision regret scale (DRS) for a first cohort of patients who are undergoing surgery for TIR3 nodules. Additionally, this investigation explores the associations between decision regret (DR) and a range of psychological, quality-of-life, demographic and clinical factors. Methods: This preliminary study included patients who underwent surgery for TIR3 disease within the past 12 months. Eligible individuals were contacted between November and December 2024 and invited to complete a digital questionnaire in Italian, incorporating the DRS, Decision Conflict Scale, Satisfaction with Decision, EuroQoL-5D and the State-Trait Anxiety Inventory-Form Y2. Twenty-seven questionnaires were completed and considered suitable for analysis. Results: The Italian adaptation of the DRS has good internal consistency (Cronbach’s α=0.7; McDonald’s ω=0.8) in this clinical setting. DRS scores significantly correlate with decision-making conflict, particularly “Effective Decision” (p=0.006) and “Values Clarity” (p=0.034). The DR gradually increased over time after surgery, from a mean of 2.23 (<6 months) to 2.56 (>1 year), with the highest variability in the intermediate group (6 months-1 year),suggesting an emotional transition phase. While no significant differences in regret were found across diagnostic categories, distribution variations suggest that a larger sample may reveal underlying differences. Among the demographic variables, age and educational level were statistically significant (p<0.05). Conclusion: This study marks the first use of the Italian DRS in the surgical management of TIR3 nodules, demonstrating its validity and reliability. These preliminary findings highlight the impact of demographic and behavioral factors on the choice of treatment and the need for tools that actively engage patients in shared decision-making.