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

Sung-eun Hong; Myung Han Hyun; Sang Hyung Lee; Bup-Woo Kim; Hee Jun Kim; Eun Ju Ko; Jee Young Lee; Hong, Sung-eun; Hyun, Myung Han; Lee, Sang Hyung; Kim, Bup-Woo; Kim, Hee Jun; Ko, Eun Ju; Lee, Jee Young

doi:10.13048/jkm.25002

JKM > Volume 46(1); 2025 > Article

Hong, Hyun, Lee, Kim, Kim, Ko, and Lee: Development and Monitoring Evaluation of the Clinical Pathway for post-operative care in patients with thyroid cancer in integrative medical center

Original Article

The Journal of Korean Medicine 2025; 46(1): 15-28.

Published online: March 01, 2025

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

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

Sung-eun Hong¹

, Myung Han Hyun¹

, Sang Hyung Lee¹

, Bup-Woo Kim²

, Hee Jun Kim²

, Eun Ju Ko¹

, Jee Young Lee¹^{, *}

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 September 19, 2024 Revised November 8, 2024 Accepted February 11, 2025

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

Supplementary materials

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

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

문항	평균±표준편차	중위수	수렴도	합의도	CVR	안정도
문헌 연구와 후향적 차트 리뷰를 바탕으로 갑상선암 수술 후 한의 표준임상경로를 개발하여 의료현장에서 제공하는 것	8.33±0.65	8	1	0.750	1	0.078
진단 및 평가 - 치료계획 - 평가 및 관리]로 이어지는 전체 진료 흐름	8.33±0.78	8.5	0.5	0.882	1	0.093
갑상선암 수술 전 한방처치로 환자의 상태와 선호에 맞춘 대증적 치료로 제시한 것	8.33±0.78	8.5	0.5	0.882	1	0.093
갑상선암 수술 후 나타날 수 있는 부작용을 그룹별로 나누고 그에 따라 치료방법을 제시한 것	8.33±0.65	8	0.5	0.875	1	0.078
갑상선암 수술 전, 후로 나누어 치료 계획을 제시한 것	8.42±0.67	8.5	0.5	0.882	1	0.079
갑상선암 수술 후 한방처치 시점을 POD #5로 제시한 것	8.17±0.94	8.5	1	0.765	1	0.115
협진병원으로서, 양한방 통합치료를 제시한 것	8.58±0.51	9	0.5	0.889	1	0.060
협진병원의 의료환경을 고려하였을 때, 진료흐름 및 내용면에서 적절하게 잘 작성되었다.	8.33±0.78	8.5	0.5	0.882	1	0.093

Table 2

CP application rate and completion rate

적용		완료
적용 건수 (n)	적용률 (%)	완료 건수 (n)	완료율 (%)
18	81.8	18	100

Table 3

Thyca-QoL questionnaire scores before and after CP application

척도	문항	CP 적용 전 점수 (평균±표준편차)	CP 적용 후 점수 (평균±표준편차)
	다중 항목 척도
신경근육 (다리 쥐남, 행동 느려짐, 관절통, 근육통)	10, 12, 13	5.89±1.41	5.44±1.01
목소리 (쉰 목소리, 약해진 목소리)	3, 4	4.56±1.95	4.17±1.46
주의력 (집중력 장애, 생각이 어려움)	20, 21	3.22±1.44	3.17±0.90
교감신경 (상열감, 열에 민감함)	8, 9	3.00±1.33	3.00±0.94
구강, 인후 (연하곤란, 목 이물감, 구강 건조)	1, 2, 5	7.33±1.80	6.06±1.81
정신심리학적 문제 (불안, 초조함, 심계항진, 갑작스러운 피로 )	17, 19, 22, 23	7.33±2.49	6.61±1.16
감각 신경계 (안구, 피부)	15, 16	3.72±1.24	3.56±1.17
	단일 항목 척도
흉터	6	2.61±0.76	2.33±0.75
오한	7	1.44±0.60	1.33±0.47
손발 저림	11	1.67±0.58	1.39±0.49
체중 증가	14	2.17±0.90	1.78±0.85
두통	18	1.94±0.70	1.50±0.50
성에 흥미 없음	24	1.11±0.31	1.44±0.60

Table 4

NRS(Neck pain) before and after CP application

Table 5

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

Question	Mean±SD
의사는 귀하의 건강 상태와 치료 과정에 대해 자세히 설명해 주었습니까?	4.55±0.51
귀하가 수술 후 불편감이 있을 때 이를 빨리 해결해 주었습니까?	4.60±0.50
의료진은 귀하가 묻는 말에 이해하기 쉽게 대답해 주었습니까?	4.55±0.51
간호사는 제공하는 간호에 대해 자세히 설명해 주었습니까?	4.60±0.50
투약 전에 약에 대한 충분한 정보(약의 효능, 부작용)를 받았습니까?	4.10±0.72
퇴원 후 갑상선암 수술 후 관리에 대해 충분한 정보를 받았습니까?	4.25±0.91

Table 6

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

Question	Mean±SD
우리 병원의 갑상선암 수술 후 양한방 통합치료를 위해 입원한 환자 프로세스(입퇴원 수속 과정 포함)에 대하여 전반적으로 만족하십니까?	4.65±0.49
갑상선암 수술 후 양한방 통합치료 대상 환자가 입원하였을 때 귀하께서 환자의 정보(이전 상태, 기저 질환 등)를 얻는 과정은 신속하고 원활합니까?	4.65±0.49
갑상선암 수술 후 양한방 통합치료 대상 환자의 입원부터 퇴원까지의 전체 프로세스에 대해서 모든 의료진이 정확하게 인지하고 있다고 생각하십니까?	4.65±0.49
갑상선암 수술 후 양한방 통합치료 과정 중에 있었던 이벤트 및 환자별 수술 후 주의 사항에 대하여, 담당 의료진 전체가 신속하게 내용을 공유합니까?	4.70±0.47
갑상선암 수술 후 양한방 통합치료 대상 환자의 입원 기간 중 의료직/비의료직 문제가 발생하였을 때, 의료진 간에 정보 공유 및 의사 결정 과정은 신속하고 원활합니까?	4.60±0.50
갑상선암 수술 후 양한방 통합치료 대상 환자의 입원부터 퇴원까지 전 과정에 있어, 각 직종이 해야할 역할이 중복이나 누락, 모호함이 없이 명확하게 분담되어 있습니까?	4.50±0.61
갑상선암 수술 후 양한방 통합치료 대상 환자 및 가족들에게 입원부터 퇴원까지의 전체 과정에 대한 정보가 충분히 제공되고 있습니까?	4.75±0.44

참고문헌

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