DOI: 10.1177/19160216261451820 ISSN: 1916-0216

Early Adoption of Thyroid Radiofrequency Ablation in Canada: Physician Experiences, Barriers, and Facilitators to Implementation

Harrison Gao, David Liu, Ben B. Levy, Justin Shapiro, Kevin M. Higgins, Diana E. Khalil, Elizabeth E. Cottrill, Courtney Poon, Pabiththa Kamalraj, Justine Philteos, Antoine Eskander
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Importance:

Thyroid radiofrequency ablation (RFA) is a minimally invasive alternative to surgery for thyroid nodules. Despite strong international evidence, thyroid RFA was only approved by Health Canada in April 2023. Understanding the experiences of early adopters can inform the broader adoption of RFA in Canada and other healthcare systems.

Objective:

To describe the implementation experiences of early adopters of thyroid RFA in Canada and identify barriers and facilitators to adoption.

Design:

Multiple methods.

Setting:

All 8 listed RFA facilities in Canada.

Participants:

Physicians performing thyroid RFA (n = 9).

Main Outcome Measures:

Survey and semi-structured interviews.

Results:

Most participants reported low RFA volumes (median [IQR] = 2.0 [0.6-3.0] cases/month) and short wait times (1.5 [1.0-2.0] months). For thyroid surgery on similar nodules, participants performed higher volumes (7.5 [6.0-10.2] cases/month, P  = .01) and had longer wait times (6.0 [5.5-8.5] months, P  < .01). Four major themes emerged: (1) financial barriers and inequity; (2) impact on the healthcare system; (3) learning curve; and (4) motivators and facilitators. Financial barriers were driven by the RFA generator ($40 500 CAD) and single-use probes ($1500-$2500 CAD). RFA was funded privately out-of-pocket in most physician practices (n = 7) and rarely publicly covered (n = 2). Motivators and facilitators included patient-centred benefits, professional development, institutional support, and potential resource savings.

Conclusions:

Thyroid RFA adoption in Canada is in its infancy, characterized by low procedural volumes, few providers, and geographical disparities. Early adopters reported positive experiences with RFA. However, inconsistent funding models, billing codes, and policy frameworks have resulted in inequitable access for patients.

Relevance:

Many healthcare systems are in the early stages of RFA adoption, similar to Canada. This study identifies key experiences, barriers, and facilitators applicable to physicians, leaders, and policymakers globally who are interested in adopting RFA.

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