{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:03:45Z","timestamp":1791972225092,"version":"4.3.4"},"reference-count":47,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Patients diagnosed with differentiated thyroid cancer (DTC) who receive radioactive iodine (RAI) treatment experience acute, medium, and late treatment effects. The timing and severity of these effects vary by individual; common posttreatment effects include dry mouth, salivary gland swelling, dry eyes, and nose bleeds. The nature of symptoms that patients experience after RAI treatment can significantly and negatively impact health-related quality of life. Adequate information during the postprimary treatment phase remains an unmet need among the population of patients diagnosed with DTC.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This qualitative study aimed to identify and understand self-management strategies for RAI-specific symptom burden from the perspectives of patients and stakeholders (cancer care providers and patient advocates). An additional aim included assessing features and functionalities desirable in the development of a web-based intervention to engage patients in their self-management and thyroid cancer survivorship care.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Following the Social Cognitive Theory framework and person-based principles, we conducted six focus groups with 22 patients diagnosed with DTC who completed RAI treatment and individual interviews with 12 stakeholders in DTC care. The interviews focused on participants\u2019 perspectives on current self-management strategies and mockups of a symptom management web-based intervention. Before focus groups and interviews, participants completed a demographics survey. Focus group discussions and interviews were transcribed and coded using content analysis. Interrater reliability was satisfactory (\u0251=.88).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 34 individuals (patients and stakeholders) participated in the study; the mean age was 45 (SD 13.4) and 45.3 (SD 13) years, respectively. Three domains emerged from qualitative interviews: (1) difficult-to-manage RAI symptoms: short, medium, and late treatment effects; (2) key intervention structure and content feedback on mockups; and (3) intervention content to promote RAI symptom management and survivorship care. Focus group participants identified the most prevalent RAI symptoms that were difficult to manage as: dry mouth (11\/22, 50%), salivary gland swelling (8\/22, 36%), and changes in taste (12\/22, 55%). Feedback elicited from both groups found education and symptom management mockup videos to be helpful in patient self-management of RAI symptoms, whereas patients and stakeholders provided mixed feedback on the benefits of a draft frequently asked questions page. Across focus groups and stakeholder interviews, nutrition-based symptom management strategies, communication with family members, and practical survivorship follow-up information emerged as helpful content to include in a future web-based supportive care intervention.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Results suggest education and symptom management videos can empower patients with DTC to self-manage mild to moderate RAI symptoms on a web-based platform. Findings emphasized the need for additional information for patients related to ongoing care following RAI treatment including social support and thyroid cancer surveillance. The findings provide insights for theoretically informed interventions and recommendations for refinements in thyroid cancer survivorship from patient and provider perspectives.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/60588","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T10:55:09Z","timestamp":1739357709000},"page":"e60588-e60588","source":"Crossref","is-referenced-by-count":8,"title":["Patient and Provider Perspectives of a Web-Based Intervention to Support Symptom Management After Radioactive Iodine Treatment for Differentiated Thyroid Cancer: Qualitative Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9226-8439","authenticated-orcid":false,"given":"Alaina L","family":"Carr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2720-1918","authenticated-orcid":false,"given":"Angela M","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2238-2666","authenticated-orcid":false,"given":"Jacqueline","family":"Jonklaas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0680-848X","authenticated-orcid":false,"given":"Kate","family":"Gabriel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8991-2342","authenticated-orcid":false,"given":"Kristen E","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8808-1631","authenticated-orcid":false,"given":"Kristi D","family":"Graves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"issue":"6","key":"R1","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1007\/s11764-020-00897-5","article-title":"Looking under the hood of \u201cthe Cadillac of cancers:\u201d radioactive iodine-related craniofacial side effects among patients with thyroid cancer","volume":"14","author":"Diamond-Rossi","journal-title":"J Cancer Surviv"},{"issue":"7","key":"R2","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1089\/thy.2016.0632","article-title":"Papillary thyroid cancer: the good and bad of the \u201cGood Cancer\u201d","volume":"27","author":"Randle","journal-title":"Thyroid"},{"issue":"10","key":"R3","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1007\/s00520-024-08850-3","article-title":"\u201cNo such thing as good cancer\u201d: a qualitative exploration of the experience of early-onset thyroid cancer in survivors","volume":"32","author":"Cho","journal-title":"Support Care Cancer"},{"key":"R4","unstructured":"SEER cancer stat facts: thyroid cancer. National Cancer Institute; URL: https:\/\/seer.cancer.gov\/statfacts\/html\/thyro.html [Accessed 25-11-2024]"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1158581","article-title":"Radioactive iodine therapy strategies for distinct types of differentiated thyroid cancer: a propensity score-matched analysis","volume":"14","author":"Guo","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines task force on thyroid nodules and differentiated thyroid cancer","volume":"26","author":"Haugen","journal-title":"Thyroid"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1053\/j.semnuclmed.2024.05.002","article-title":"Radioactive iodine therapy in differentiated thyroid cancer: an update on dose recommendations and risk of secondary primary malignancies","volume":"54","author":"Nguyen","journal-title":"Semin Nucl Med"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.surg.2019.01.034","article-title":"Clinical factors associated with worse quality-of-life scores in United States thyroid cancer survivors","volume":"166","author":"Goswami","journal-title":"Surgery"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1016\/j.surg.2018.06.042","article-title":"Benchmarking health-related quality of life in thyroid cancer versus other cancers and United States normative data","volume":"164","author":"Goswami","journal-title":"Surgery"},{"issue":"3","key":"R10","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1007\/s00268-015-3300-5","article-title":"Quality of life in thyroid cancer is similar to that of other cancers with worse survival","volume":"40","author":"Applewhite","journal-title":"World J Surg"},{"issue":"6","key":"R11","first-page":"15N","volume":"63","author":"Avram","journal-title":"J Nucl Med"},{"issue":"11","key":"R12","doi-asserted-by":"publisher","first-page":"3446","DOI":"10.1002\/hed.26417","article-title":"Salivary and lacrimal dysfunction after radioactive iodine for differentiated thyroid cancer: American Head and Neck Society Endocrine Surgery Section and Salivary Gland Section joint multidisciplinary clinical consensus statement of otolaryngology, ophthalmology, nuclear medicine and endocrinology","volume":"42","author":"Singer","journal-title":"Head Neck"},{"issue":"4","key":"R13","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.8722","article-title":"Physician perspectives of overdiagnosis and overtreatment of low-risk papillary thyroid cancer in the US","volume":"5","author":"Dedhia","journal-title":"JAMA Netw Open"},{"key":"R14","unstructured":"Thyroid carcinoma. NCCN clinical practice guidelines in oncology version 5. 2025. URL: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/thyroid_blocks.pdf [Accessed 04-03-2025]"},{"issue":"11","key":"R15","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.6004\/jnccn.2010.0094","article-title":"Complications of radioactive iodine treatment of thyroid carcinoma","volume":"8","author":"Lee","journal-title":"J Natl Compr Cancer Netw"},{"issue":"12","key":"R16","doi-asserted-by":"publisher","first-page":"1806","DOI":"10.1089\/thy.2014.0162","article-title":"Nasal symptoms after radioiodine therapy: a rarely described side effect with similar frequency to lacrimal dysfunction","volume":"24","author":"Jonklaas","journal-title":"Thyroid"},{"issue":"3","key":"R17","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1007\/BF03401308","article-title":"Results of the Thyroid Cancer Alliance international patient\/survivor survey: psychosocial\/informational support needs, treatment side effects and international differences in care","volume":"12","author":"Banach","journal-title":"Hormones (Athens)"},{"issue":"S1","key":"R18","doi-asserted-by":"publisher","first-page":"A","DOI":"10.1089\/thy.2023.29156.abstracts","article-title":"Health-related quality of life associations in patients with differentiated thyroid cancer after radioactive iodine treatment: a cross-sectional study","volume":"33","author":"Carr","journal-title":"Thyroid\u00ae"},{"issue":"9","key":"R19","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1089\/thy.2016.0039","article-title":"A systematic review of unmet information and psychosocial support needs of adults diagnosed with thyroid cancer","volume":"26","author":"Hyun","journal-title":"Thyroid"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1027\/1016-9040\/a000351","article-title":"Integrating behavioral science with mobile (mHealth) technology to optimize health behavior change interventions","volume":"24","author":"Walsh","journal-title":"Eur Psychol"},{"issue":"5","key":"R21","doi-asserted-by":"publisher","first-page":"e240","DOI":"10.1016\/S1470-2045(20)30021-8","article-title":"The increasing value of eHealth in the delivery of patient-centred cancer care","volume":"21","author":"Penedo","journal-title":"Lancet Oncol"},{"issue":"4","key":"R22","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1002\/pon.5310","article-title":"Digital interventions to facilitate patient-provider communication in cancer care: a systematic review","volume":"29","author":"Hong","journal-title":"Psychooncology"},{"issue":"11","key":"R23","doi-asserted-by":"publisher","first-page":"2009","DOI":"10.1093\/tbm\/ibab033","article-title":"Emerging digital technologies in cancer treatment, prevention, and control","volume":"11","author":"Hesse","journal-title":"Transl Behav Med"},{"issue":"10","key":"R24","doi-asserted-by":"publisher","first-page":"4589","DOI":"10.1007\/s00520-020-05539-1","article-title":"Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives","volume":"28","author":"Aapro","journal-title":"Support Care Cancer"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1007\/s13187-014-0761-4","article-title":"mHealth education applications along the cancer continuum","volume":"30","author":"Davis","journal-title":"J Cancer Educ"},{"issue":"12","key":"R26","doi-asserted-by":"publisher","DOI":"10.2196\/10026","article-title":"Use of mobile devices to help cancer patients meet their information needs in non-inpatient settings: systematic review","volume":"6","author":"Richards","journal-title":"JMIR Mhealth Uhealth"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth.2016.09.02","article-title":"Integration of advances in social media and mHealth technology are pivotal to successful cancer prevention and control","volume":"2","author":"O\u2019Leary","journal-title":"Mhealth"},{"issue":"2","key":"R28","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s00520-017-3882-6","article-title":"Effects of web-based interventions on cancer patients\u2019 symptoms: review of randomized trials","volume":"26","author":"Fridriksdottir","journal-title":"Support Care Cancer"},{"issue":"2","key":"R29","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s00520-017-3900-8","article-title":"Effectiveness of internet-based interventions in managing chemotherapy-related symptoms in patients with cancer: a systematic literature review","volume":"26","author":"Moradian","journal-title":"Support Care Cancer"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1177\/1090198104263660","article-title":"Health promotion by social cognitive means","volume":"31","author":"Bandura","journal-title":"Health Educ Behav Off Publ Soc Public Health Educ"},{"issue":"2","key":"R31","first-page":"210","volume":"22","author":"Graves","journal-title":"Health Psychol Off J Div Health Psychol Am Psychol Assoc"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4055","article-title":"The person-based approach to intervention development: application to digital health-related behavior change interventions","volume":"17","author":"Yardley","journal-title":"J Med Internet Res"},{"issue":"2","key":"R33","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s11764-014-0413-z","article-title":"A systematic review and meta-analysis of social cognitive theory-based physical activity and\/or nutrition behavior change interventions for cancer survivors","volume":"9","author":"Stacey","journal-title":"J Cancer Surviv"},{"issue":"6","key":"R34","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1097\/00002820-200411000-00006","article-title":"Exploring social cognitive theory constructs for promoting exercise among breast cancer patients","volume":"27","author":"Rogers","journal-title":"Cancer Nurs"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1002\/pon.3082","article-title":"Evaluation of a social cognitive theory-based email intervention designed to influence the physical activity of survivors of breast cancer","volume":"22","author":"Hatchett","journal-title":"Psychooncology"},{"issue":"4","key":"R36","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.ejon.2012.10.009","article-title":"How social cognitive theory can help oncology-based health professionals promote physical activity among breast cancer survivors","volume":"17","author":"Short","journal-title":"Eur J Oncol Nurs"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1017\/s1478951503030268","article-title":"Quality of life pilot intervention for breast cancer patients: use of social cognitive theory","volume":"1","author":"Graves","journal-title":"Palliat Support Care"},{"issue":"6","key":"R38","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","journal-title":"Int J Qual Health Care"},{"issue":"2","key":"R39","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","journal-title":"J Biomed Inform"},{"issue":"2","key":"R40","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"issue":"1","key":"R41","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1177\/001316447003000105","article-title":"Estimating the reliability, systematic error and random error of interval data","volume":"30","author":"Krippendorff","journal-title":"Educ Psychol Meas"},{"key":"R42","unstructured":"Krippendorff K . Content Analysis: An Introduction to Its Methodology. 2nded. SAGE Publications; 2004. ISBN: 0761915443"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1016\/j.mex.2023.102545","article-title":"K-alpha calculator-Krippendorff\u2019s alpha calculator: a user-friendly tool for computing Krippendorff\u2019s alpha inter-rater reliability coefficient","volume":"12","author":"Marzi","journal-title":"MethodsX"},{"issue":"3","key":"R44","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1002\/cncr.33947","article-title":"Cancer health self-efficacy improvement in a randomized controlled trial","volume":"128","author":"Leach","journal-title":"Cancer"},{"issue":"5","key":"R45","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1007\/s00520-017-3999-7","article-title":"Self-management interventions for cancer survivors: a systematic review","volume":"26","author":"Boland","journal-title":"Support Care Cancer"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3390\/cancers16010014","article-title":"Characteristics and components of self-management interventions for improving quality of life in cancer survivors: a systematic review","volume":"16","author":"Rimmer","journal-title":"Cancers (Basel)"},{"issue":"11","key":"R47","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1016\/j.eprac.2024.08.003","article-title":"Thyroid cancer survivorship: challenges and opportunities","volume":"30","author":"Kotwal","journal-title":"Endocr Pract"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e60588","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:31:46Z","timestamp":1785537106000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e60588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,19]]},"references-count":47,"URL":"https:\/\/doi.org\/10.2196\/60588","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,19]]},"article-number":"v9i6e60588"}}