MP42-15 DEVELOPMENT OF A PATIENT DECISION AID FOR COMPLEX, LOCALIZED RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2018MP42-15 DEVELOPMENT OF A PATIENT DECISION AID FOR COMPLEX, LOCALIZED RENAL MASSES Kristen McAlpine, Rodney H. Breau, Dawn Stacey, Christopher Knee, and Luke T. Lavallée Kristen McAlpineKristen McAlpine More articles by this author , Rodney H. BreauRodney H. Breau More articles by this author , Dawn StaceyDawn Stacey More articles by this author , Christopher KneeChristopher Knee More articles by this author , and Luke T. LavalléeLuke T. Lavallée More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1322AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patient decision aids are structured clinical tools that facilitate shared decision-making. Decision aids present therapeutic options and their associated risks and benefits in an explicit and evidence-based fashion. Importantly, patient decision aids help patients clarify and communicate their values and preferences. In urology, one of the most challenging and controversial decisions is between an open partial nephrectomy and a laparoscopic radical nephrectomy to remove a complex renal mass. We sought to develop and evaluate a patient decision aid to address this challenge. METHODS The International Patient Decision Aids Standards (IPDAS) and the Ottawa Decision Support Framework (ODSF) were used to guide the systematic development of the patient decision aid. A comprehensive review of the literature was performed to identify evidence on options for management of complex, localized renal masses (cT1b-T2). The content (management options and outcomes) of the decision aid was agreed upon by content and methodological experts using an iterative feedback process. A mixed methods survey (quantitative and qualitative questions) was created to assess the decision-making experience for patients who used the patient decision aid (intervention) and those who had not (control). The primary outcomes were patient decisional conflict, knowledge and satisfaction. RESULTS A structured, evidence-based patient decision aid presented evidence on three options including probabilities of benefits and risks of outcomes. Open partial nephrectomy, laparoscopic radical nephrectomy and observation were the defined management options. Patient decisional needs identified through the literature review were addressed. Included outcomes were: bleeding, urine leak, length of stay, end stage renal disease, cancer-specific and overall survival. Simple language and pictures were used to present data at a level suitable for a wide range of patients. A validated screening instrument (SURE test) was included with 4 questions measuring patients′ decisional conflict. Four knowledge questions were included to verify patients′ understanding. The decision aid met all IPDAS criteria to be defined as a decision aid, 5 of 6 IPDAS criteria for certification and 17 of 23 quality criteria. CONCLUSIONS A patient decision aid was created to facilitate shared-decision making for patients with newly diagnosed complex renal masses deciding between an open partial and laparoscopic radical nephrectomy. The effectiveness of our decision aid is currently being evaluated prospectively. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e542 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kristen McAlpine More articles by this author Rodney H. Breau More articles by this author Dawn Stacey More articles by this author Christopher Knee More articles by this author Luke T. Lavallée More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...