Physician perspectives on decision-making in low-risk papillary thyroid microcarcinoma in South Korea: a cross-sectional survey of physicians

Abstract Background In patients with low-risk papillary thyroid microcarcinoma (PTMC), the choice between surgery and active surveillance (AS) should be made through shared decision-making. However, implementing this process in routine practice remains challenging. We aimed to examine physicians’ perspectives in South Korea on treatment decision-making for low-risk PTMC. Methods We conducted an exploratory cross-sectional survey among physicians involved in the management of low-risk PTMC in South Korea. The survey included structured items and open-ended questions addressing information needs, physician concerns, follow-up issues, and medical and socioeconomic priorities related to decision-making between AS and surgery. Structured responses were summarized descriptively, and free-text responses were analyzed using qualitative content analysis and then quantified using counts and percentages. Results A total of 33 physicians participated in the survey. When determining the initial treatment plan, key factors highlighted included patient age, tumor location, and lymph node metastasis status. When explaining treatment options to patients, prominent themes included cancer progression rate, tumor location, and AS itself. During AS and follow-up, physicians emphasized surveillance frequency and test methods. Physicians also expressed concerns related to disease progression, patient preference for surgery, and patient anxiety. In addition, the need for clearer AS protocols, standardized imaging practices, and broader insurance support emerged as important issues. Conclusions This survey identifies key clinical, communication-related, and health system factors that physicians consider important in treatment decision-making for low-risk PTMC. These findings support the development of decision-support resources and clearer practice frameworks for shared decision-making.