Shared Care Thyroid Cancer Follow-up Utilizing Thyroid Cancer Assessment Reminder System (TCARS) Study - A Pilot Study.

These outcomes will assess the feasibility of the pilot study. These include:

• Number (%) of eligible patients who are approached for the study and agree to participate in either group.
• Number (%) of eligible patients who are are approached for the study but refuse to participate in either group and reason for refusal.
• Number (%) of patients who remain in the shared-care group at study end.
• Number of patients who choose to terminate the study in either group and reason for termination.
• Number of patients who lost their PCP and returned to specialist care.

These outcomes will be measured to compare shared-care vs control DTC patients during the study duration and prospectively entered into a computerized DTC outcome registry of all study patients to follow their progress. This will be separate from TCARS, which will contain no clinical information.This information will be entered by the study coordinator. These include:

• Number (%) of patients having annual TG/anti-TG AB.
• Number (%) of patients having annual neck ultrasound.
• Number (%) of patients with TSH test every 6 months.
• Number (%) of patients with TSH within target range and if outside target, whether thyroxine dose was adjusted and TSH rechecked.
• Number (%) of patients with abnormal findings on neck ultrasound or TG/anti-TG AB test.
• Number (%) of patients who were referred back to ITOC using the expedited referral sheet and reason for referral.

Patient satisfaction will be assessed in both groups using the Patient Satisfaction Questionnaire Short form (PSQ -18). The PSQ-18 is a Likert scale questionnaire, consisting of 18 items tapping each of the seven dimensions of satisfaction with medical care. These are 1) general satisfaction, 2) technical quality, 3) interpersonal manner, 4) communication, 5) financial aspects, 6) time spent with doctor, and 7) accessibility and convenience.

Patient and provider satisfaction, acceptability and experience will be assessed through qualitative data gathered by provider (Specialist and PCP) interviews (n=8) and patient focus groups (n=12-16; 2 groups of 6-8 participants each).

PCP involvement and confidence in DTC management outcomes will be based on previously published surveys.

The survey is based on the National Cancer Institute Survey of Physician Attitudes Regarding the Care of Cancer Survivors which was modified for thyroid cancer. In addition to the standard survey items, PCPs will be asked to report how confident they are in discussing key aspects of follow-up care with thyroid cancer survivors including:

• Role of serum hsTG and anti-TG AB in long term surveillance.
• Role of neck US in long term surveillance.
• When to end long term surveillance.
• When to refer back to specialist. All responses will be on a 5-point Likert type not at all confident to very confident.

Feedback on the use of the Medable (DCT) system will be assessed using qualitative data gathered through patient and PCP surveys. Some responses will be on a 5-point Likert-type scale from strongly disagree to strongly agree or very unlikely to likely. Other questions will be in a multiple choice format. An open dialogue box will appear at the end of the survey for respondents to enter additional comments.