$3.8 Million NIH Grant awarded to Improve Thyriod Cancer Survivorship Care
How can we improve thyroid hormone management in older adults to reduce misuse and overtreatment? Older adults have a disproportionately higher prevalence of hypothyroidism compared to their younger counterparts, with levothyroxine (the most widely used synthetic thyroid hormone) consistently one of the top most frequently prescribed medications in the United States. Alarmingly, up to 48% of older adults aged ³65 years receive a thyroid hormone dose that is too high, resulting in overtreatment. In addition, thyroid hormone therapy is often initiated for inappropriate indications (misuse) which can also lead to overtreatment and to significant cardiovascular and skeletal risks, and increased mortality. This is especially concerning for older adults, who comprise the fastest growing demographic group and the most vulnerable to polypharmacy.
With a $3.8 million dollar grant from the National Institute on Aging, DHI member Dr. Maria Papaleontiou and collaborators, including PH’s Assistant Director of Data Analytics & IT Workgroup Dr. Megan Haymart, and Drs. Mousumi Banerjee, Sarah Hawley and Lauren Wallner, are conducting the first multi-site trial to evaluate a novel evidence-based adapted multilevel intervention, D-THIO (Deprescribing Thyroid Hormone In Older Adults), consisting of evidence-based pharmaceutical opinion to providers, education brochures to patients and facilitated by clinical champions, to support thyroid hormone deprescribing in older adults. The clinician-directed arm of the intervention will be integrated in the electronic health record and supported by Precision’s Health Implementation Workgroup.
This trial of D-THIO vs enhanced usual care will assess the effectiveness of D-THIO on thyroid hormone deprescribing by providers, on reducing overtreatment and misuse with thyroid hormone, as well as on provider and patient knowledge and attitudes regarding thyroid hormone deprescribing via surveys. In addition, the study team will identify factors related to the implementation of D-THIO across diverse general care settings via post-trial interviews with key stakeholders.
Ultimately, findings from this study will serve as a model for deprescribing inappropriate medications for other endocrine conditions and conditions with biochemical monitoring, and advance our understanding of de-implementation of low-value care in older adults across the nation.
We has supported this project with the implementation of the D-THIO intervention materials in the EHR at the University of Michigan Health System, helping to enable this on-going research.