PD32-10 DECISIONAL CONFLICT AMONG PATIENTS NEWLY DIAGNOSED WITH CLINICAL T1 RENAL MASSES

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD32-10 DECISIONAL CONFLICT AMONG PATIENTS NEWLY DIAGNOSED WITH CLINICAL T1 RENAL MASSES Amir Feinberg, Kathryn Gessner, Shannon Myers, Hillary Heiling, Allison Deal, Sara Wobker, Allison Lazard, Marc Bjurlin, Mathew Raynor, Matthew Nielsen, Angela Smith, Eric Wallen, David Johnson, William Kim, and Hung-Jui Tan Amir FeinbergAmir Feinberg More articles by this author , Kathryn GessnerKathryn Gessner More articles by this author , Shannon MyersShannon Myers More articles by this author , Hillary HeilingHillary Heiling More articles by this author , Allison DealAllison Deal More articles by this author , Sara WobkerSara Wobker More articles by this author , Allison LazardAllison Lazard More articles by this author , Marc BjurlinMarc Bjurlin More articles by this author , Mathew RaynorMathew Raynor More articles by this author , Matthew NielsenMatthew Nielsen More articles by this author , Angela SmithAngela Smith More articles by this author , Eric WallenEric Wallen More articles by this author , David JohnsonDavid Johnson More articles by this author , William KimWilliam Kim More articles by this author , and Hung-Jui TanHung-Jui Tan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Increasingly, the management of clinical T1 renal masses has become a complex, preference-sensitive decision due to their favorable prognosis and multitude of management options. However, having multiple options can also generate significant decisional conflict and ultimately regret. Accordingly, we sought to evaluate factors driving decisional conflict among patients with clinical T1 renal masses suspicious for kidney cancer. METHODS: From October 2018–June 2022, we prospectively enrolled patients with new clinical T1 renal masses onto GRADE-SRM, a non-randomized hybrid trial investigating the decision-making experience and cancer genomics. Participants completed surveys on their demographics, health status, and patient-centered communication. Beginning in June 2019, participants also completed surveys on their health status and decision-making traits (e.g., self-efficacy, maximizer-minimizer, autonomy preference, literacy, numeracy). For this analysis, decisional conflict served as the primary outcome as measured by the decisional conflict scale (DCS). We compared DCS score by patient and clinical factors using bivariable linear regression analyses. RESULTS: Overall, 236 of 265 enrollees completed a baseline DCS survey. Mean age was 62.4 years (SD 11.2), 61.4% were male, and 31.3% were non-White. While 74.9% had masses ≤4cm in size, 10.7% had high complexity tumors, 5.9% had bilateral masses, and 6.4% had multifocal masses. Overall, mean DCS score was 16.8 (SD 14.1) though 38.1% had a high DCS score (≥25). DCS scores increased with age (p=0.003). Patients with high complexity (p=0.032), cystic (p=0.043), or multifocal (p=0.037) masses had higher DCS scores compared to their counterparts. DCS scores increased with lower self-efficacy (p<0.001) but did not differ based on maximizer-minimizer tendency or numeracy. Patients with less information-seeking behavior and worse perceived communication experienced more decisional conflict (p<0.001). CONCLUSIONS: Over a third of patients with newly diagnosed clinical T1 renal masses suspicious for kidney cancer experience significant decisional conflict. High scores seemed to be driven by tumor complexity, self-efficacy, information-seeking, and perceived communication, perhaps relating to both the potential risks of treatment and the importance of patient-provider communication. Efforts to improve the decision-making experience will need to focus on the collaborative aspects of shared decision-making. Source of Funding: This work was supported by funding from the National Institutes of Health (UNC Integrated Translational Oncology Program T32-CA244125 to UNC/khg) and UNC Lineberger Comprehensive Cancer Center UNCseq v2 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e911 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amir Feinberg More articles by this author Kathryn Gessner More articles by this author Shannon Myers More articles by this author Hillary Heiling More articles by this author Allison Deal More articles by this author Sara Wobker More articles by this author Allison Lazard More articles by this author Marc Bjurlin More articles by this author Mathew Raynor More articles by this author Matthew Nielsen More articles by this author Angela Smith More articles by this author Eric Wallen More articles by this author David Johnson More articles by this author William Kim More articles by this author Hung-Jui Tan More articles by this author Expand All Advertisement PDF downloadLoading ...