Abstract
ABSTRACTObjectives To evaluate the efficacy of a novel decision aid (DA) in improving the patients’ level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone <2 cm.Materials and Methods In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge.Results Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge.Conclusions In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone <20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.
Highlights
Stone disease is reported to have a prevalence of 8.8% in the United States and this prevalence has a tendency increase (1)
Two patients in each group did not undergo the evaluation after informing processes and data of 57 and 58 patients were analyzed
The number of patients with adequate knowledge after informing process was significantly higher in group 2 compared to group 1 (32 (56.1%) vs. 43 (74.1%), p = 0.04))
Summary
Stone disease is reported to have a prevalence of 8.8% in the United States and this prevalence has a tendency increase (1). Careful evaluation and appropriate management of stone disease is crucial considering its short and long term effects on patient’s quality of life and renal functions. Both shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) are recommended for the management of non - lower pole renal stones < 20 mm in diameter by the most recent AUA and EAU guidelines (2, 3). The decision making process for management of stone disease relies on factors influenced by either the patient or the physician. In another study, the management behaviors of urologists for a lower pole stone was investigated with a web based survey and 81.2% of the participants responded that patient’s preferences were important for decision making. Involvement of patient in the decision making process should be facilitated and appropriate tools for patient education are required for this purpose (5)
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