PD32-08 THE EFFECT OF VISUAL AND NUMERIC RISK INFORMATION ON SURGEON BEHAVIOR: A RANDOMIZED, CLINICAL VIGNETTE EXPERIMENT

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD32-08 THE EFFECT OF VISUAL AND NUMERIC RISK INFORMATION ON SURGEON BEHAVIOR: A RANDOMIZED, CLINICAL VIGNETTE EXPERIMENT Hung-Jui Tan, David Gotz, Hillary Heiling, Allison Deal, Kara Giannone, Debra Usinger, Sue Blalock, Antonia Bennett, Matthew Nielsen, Daniel Reuland, Alex Sox-Harris, Allison Lazard, Greg Sacks, and Ethan Basch Hung-Jui TanHung-Jui Tan More articles by this author , David GotzDavid Gotz More articles by this author , Hillary HeilingHillary Heiling More articles by this author , Allison DealAllison Deal More articles by this author , Kara GiannoneKara Giannone More articles by this author , Debra UsingerDebra Usinger More articles by this author , Sue BlalockSue Blalock More articles by this author , Antonia BennettAntonia Bennett More articles by this author , Matthew NielsenMatthew Nielsen More articles by this author , Daniel ReulandDaniel Reuland More articles by this author , Alex Sox-HarrisAlex Sox-Harris More articles by this author , Allison LazardAllison Lazard More articles by this author , Greg SacksGreg Sacks More articles by this author , and Ethan BaschEthan Basch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The treatment patients receive depends more on their surgeon than their disease. Risk prediction tools aim to address this quandary by providing quantitative risk information, but their clinical impact remains limited. Because data visualization can improve information processing, we designed a visual risk display and tested its impact on surgical decision-making. METHODS: We engaged a panel of urologists to develop a multidimensional, multifaceted visual risk display through user-centered design. The panel further helped us develop clinical vignettes for favorable intermediate risk prostate cancer (A), high risk prostate cancer (B), small renal mass (C), advanced kidney cancer (D), BCG unresponsive, noninvasive bladder cancer (E), and muscle-invasive bladder cancer (F) where surgical equipoise exist. From May–June 2022, we administered these vignettes to SUO and AUA members via Qualtrics, randomizing them to the visual risk display, numeric risk information, and control. Risk estimates were generated from existing risk prediction tools. For each case, respondents rated how likely they would recommend surgery (5-point Likert: strongly against to strongly for surgery) and selected health services they would obtain prior to surgery. Responses were compared using Fisher’s MC exact test with significance level set at 0.05. RESULTS: In total, 333 urologists participated: 104 in the visual arm, 111 in the numeric arm, and 118 in the control arm. Respondents were mostly fellowship-trained (71.2%) and in academic practices (60.1%). A strong or somewhat for surgery recommendation varied by case (A: 19.2%, B: 65.2%, C: 51.9%, D: 51.3%, E: 52.3%, F: 68.8%) but did not differ statistically across arms (p=0.210–0.967). In contrast, the selection of healthcare services such as preoperative care, cardiac clearance, and pulmonary clearance did differ statistically across arms depending on the case (Figure). CONCLUSIONS: Risk information—whether visual or numeric—did not affect a surgeon’s recommendation for surgery, highlighting the strong intuitive nature of surgical decision-making. However, the selection of health services appears more movable, indicating a role for risk prediction tools in optimizing surgical readiness and clinical outcomes. Source of Funding: American Cancer Society © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e910 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hung-Jui Tan More articles by this author David Gotz More articles by this author Hillary Heiling More articles by this author Allison Deal More articles by this author Kara Giannone More articles by this author Debra Usinger More articles by this author Sue Blalock More articles by this author Antonia Bennett More articles by this author Matthew Nielsen More articles by this author Daniel Reuland More articles by this author Alex Sox-Harris More articles by this author Allison Lazard More articles by this author Greg Sacks More articles by this author Ethan Basch More articles by this author Expand All Advertisement PDF downloadLoading ...