Purpose:

Patients residing in rural and frontier areas experience worse thyroid cancer outcomes than those in urban areas. This novel qualitative study sought the perspectives of rural surgeons to identify practical measures that could mitigate the disparities in thyroid cancer care between rural and urban contexts. 

Methods:

We contacted general and head and neck surgeons from California’s Critical Access Hospitals (n=35) and requested self-referral to our study through the American College of Surgeons. We performed semi-structured qualitative interviews with surgeons at rural hospitals to understand the assets and vulnerabilities of rural hospitals in providing the highest quality care to patients with thyroid cancer. Responses were coded and analyzed using mixed-methods qualitative analysis methodology.

Results:

Rural surgeons (n=12) from a geographically diverse sample of states (AK, AR, CA, NE, NC, NM, TX, UT, WY) participated. All initially trained in general surgery; 50% had fellowship training (17% in endocrine surgery) and performed a median of 8.5 thyroidectomies annually.

Rural surgeons from all training backgrounds felt adequately trained to treat thyroid cancer and reported a strong desire to provide comprehensive thyroid cancer care. Most reported patients’ strong preference to be treated near home. Key challenges to local, comprehensive thyroid cancer care included: limited or no access to medical endocrinology, lack of continuing education on thyroid cancer management, and professional isolation in decision-making. One surgeon reported significant resource constraints, specifically lack of nerve monitoring and inexperienced operating room staff. Rural surgeons identified connections with university health systems, expert colleagues, and telemedicine consultations as valuable assets in treating thyroid cancer in geographically isolated hospitals.

Conclusion:

This study identified key challenges and clear avenues for interventions in treating rural thyroid cancer patients. Rural surgeons suggest improving access to endocrinology specialists, developing educational initiatives on thyroid cancer management, and fostering connections with urban colleagues to reduce professional isolation.