Development and Monitoring Evaluation of the Clinical Pathway for post-operative care in patients with thyroid cancer in integrative medical center

Article information

J Korean Med. 2025;46(1):15-28

Publication date (electronic) : 2025 March 01

doi : https://doi.org/10.13048/jkm.25002

Sung-eun Hong ¹

, Myung Han Hyun ¹

, Sang Hyung Lee ¹

, Bup-Woo Kim ²

, Hee Jun Kim ²

, Eun Ju Ko ¹

, Jee Young Lee ¹^,

¹Integrative Cancer Center, CHA Ilsan Medical Center, CHA university

²Department of Surgery, CHA Ilsan Medical Center, CHA University School of Medicine

Correspondence to: Jee Young Lee, Integrative Cancer Center, Cha Ilsan Medical Center, Jungang-ro 1205, Goyang-si, Gyeonggi-do, Rep of Korea, Tel: +82-31-782-3113, F: +82-31-782-3105, E-mail: happiade@chamc.co.kr

Received 2024 September 19; Revised 2024 November 8; Accepted 2025 February 11.

Abstract

Objectives

This study aimed to develop a clinical pathway (CP) for post-operative care in patients with thyroid cancer in integrative medical center setting, specifically targeting the improvement of quality of life (QoL) and clinical management standardization. The CP was refined through a modified Delphi method and subsequently monitored in a clinical setting.

Methods

The CP model was based on an analysis of medical records of thyroid cancer patients from July 2022 to February 2024. A time-task matrix was established, categorizing tasks by timeline (pre-operative, operation day, post-operative) and clinical activities (KM (Korean Medicine) evaluation, treatment, activity, diet, education). The draft CP model was validated using the modified Delphi method. Finally, the CP was pilot-tested in a clinical environment monitoring indicators such as CP application rate, completion rate, QoL, and satisfaction levels. To evaluate the CP, THYCA-QoL questionnaire was used, and pain levels were assessed using the Numeric Rating Scale (NRS).

Results

The final CP model showed 81.8% application rate and 100% completion rate during the monitoring period. Results of THYCA-QoL questionnaire showed significant improvement in various aspects, including neuromuscula, oral and throat, and psychological issues. The NRS indicated a 48.1% reduction in neck pain intensity after post-CP application. Both patient and medical staff satisfaction increased following the CP’s application

Conclusions

The integrative CP model for post-operative care in thyroid cancer patients improved QoL and reduced pain, demonstrating its potential as a standardized tool of integrative cancer healthcare settings. Future studies should refine the model and expand its use to validate efficacy and optimize quality of care.

Keywords: Thyroid cancer; clinical pathway; integrative medicine; modified Delphi; post -operative care

Fig. 1

Development process of clinical pathway of integrative post-operative care in patients with thyroid cancer.

Fig. 2

Treatment algorithm of integrative post-operative care in patients with thyroid cancer

Table 1

Validity analysis of the CP in integrative medicine for patients treated with thyroidectomy

Table 2

CP application rate and completion rate

Table 3

Thyca-QoL questionnaire scores before and after CP application

Table 4

NRS(Neck pain) before and after CP application

Table 5

The mean and standard deviation of scores in the patient satisfaction survey

Table 6

The mean and standard deviation of scores in the employee satisfaction survey

Supplementary materials

jkm-46-1-15-Supplementary-Materials-1.pdf

References

1. Ahn H., Park Y.. 2009;Incidence and clinical characteristics of thyroid cancer in Korea. Korean Journal of Medicine 77(5):537–542.

2. Haddad RI., Bischoff L., Ball D., et al. 2022;Thyroid carcinoma, version 2.2022, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network 20(8):925–951. https://doi.org/10.6004/jnccn.2022.0049.

3. Lee G., Lee E., Kang H., et al. 2016;2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. International Journal of Thyroidology 9(2):59–126.

4. Davies L., Welch HG.. 2006;Increasing incidence of thyroid cancer in the United States, 1973–2002. Jama 295(18):2164–2167. https://doi.org/10.1001/jama.295.18.2164.

5. Li M., Dal Maso L., Vaccarella S.. 2020;Global trends in thyroid cancer incidence and the impact of overdiagnosis. The Lancet Diabetes & Endocrinology 8(6):468–470. https://doi.org/10.1016/S2213-8587(20)30115-0.

6. Center NCI. 갑상선암 2023. https://www.cancer.go.kr/lay1/program/S1T211C212/cancer/view.do?cancer_seq=3341&menu_seq=3346#. Accessed Feb 25, 2024.

7. Kim Y., Song D., Lee K., et al. 2012;Comparison of palonosetron with ondansetron in preventing postoperative nausea and vomiting after thyroidectomy during a 48-hour period. Anesthesia and Pain Medicine 7(4):312–316.

8. Lee K., Lee G.. 2013;Phenomenology of the Experiences of Women with Thyroidectomy. Korean Oncology Nursing Society 13(3):152–162.

9. Lee J., Shin D., Cho B.. 2014;The current status of cancer survivorship care and a consideration of appropriate care model in Korea. Korean Journal of Clinical Oncology 10(2):58–62. https://doi.org/10.14216/kjco.2014.10.2.58.

10. Lee J., Jeong M., Jung J.. 2008;Tumor Regression Effect of Allergen-removed Rhus Verniciflua Stokes based Traditional Korean Medicine on a Patient with Metastatic Papillary Thyroid Carcinoma : Single Case Report. Journal of Internal Korean Medicine 29(3):827–834.

11. Lee S., Kim K., Yoon J., et al. 2012;Case Report on Three Cases of Postoperative Pain after Thyroidectomy Treated with Gamisoyo-sa. The Society of Pathology in Korean Medicine 26(5):793–796.

12. Go E., Jang K., Yang J., Oh J.. 2021;A Case Report on Papillary Thyroid Cancer Patients after Thyroidectomy Treated with Korean Medicine and Immunotherapy. Journal of Internal Korean Medicine 42(5)

13. Kim D., Lee S., Lee H., Moon B., Yoon J.. 2018;A Case Report of a Thyroid Cancer Patient with Hypoparathyroidism after Total Thyroidectomy by a Combination of Korean-Western Medicine Treatment Including Insamyangyoung-tang. Journal of Internal Korean Medicine 39(4)

14. Every NR., Hochman J., Becker R., Kopecky S., Cannon CP.. 2000;Critical pathways: A review. Circulation 101(4):461–465. https://doi.org/10.1161/01.cir.101.4.461.

15. Lee J.. 2001;Delphi method. Journal of Planning and Policy (299):53–62.

16. Jeong Y., Choi J., Ahn AL., et al. 2015;Validation of the Korean version of the thyroid cancer-specific quality of life questionnaire. Annals of Surgical Treatment and Research 89(6):287–293. https://doi.org/10.4174/astr.2015.89.6.287.

17. Kang Y., Park J., Gu I.. 2008;Validation of the self-concept and self-acceptance test for people with disabilities. Korea Employment Agency for Persons with Disabilities

18. Noh S.. 2006;Delphi technique: Predict the future with professional insights. Planning and Policy (299):53–62.

19. Lawshe CH.. 1975;A quantitative approach to content validity. Personnel Psychology 28(4):563–575. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x.

20. Park Y., Lee E., Song Y., et al. 2023;2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules. International Journal of Thyroidology 16(1):1–31.

21. Montazeri A.. 2009;Quality of life data as prognostic indicators of survival in cancer patients: An overview of the literature from 1982 to 2008. Health and Quality of Life Outcomes 7:1–21. https://doi.org/10.1186/1477-7525-7-102.

22. Seo S., Kim H., Lee S., et al. 2022;A Study on the Perception of Concurrent Use of Western and Korean Medicine Care and Integrated Medical Service in Korea - Targeting tertiary hospital users–. Journal of Korean Medicine 43(2):51–60. https://doi.org/10.22246/jikm.2022.43.2.510.

Article information Continued