You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-05 LIVING WITH URINARY DIVERSIONS: PATIENT INSIGHTS TO IMPROVE THE PERIOPERATIVE EXPERIENCE Geraldine Theresa Klein*, Divya Ajay, Robert Volk, Viola Leal, Vikram Narayan, and Ouida Lenaine Westney Geraldine Theresa Klein*Geraldine Theresa Klein* More articles by this author , Divya AjayDivya Ajay More articles by this author , Robert VolkRobert Volk More articles by this author , Viola LealViola Leal More articles by this author , Vikram NarayanVikram Narayan More articles by this author , and Ouida Lenaine WestneyOuida Lenaine Westney More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Few high-quality studies exist evaluating the validity and effectiveness of current education materials for patients undergoing a urinary diversion. The aim of our study is to evaluate and optimize the perioperative decision-making process at a high volume cancer center using patients’ insights. METHODS: Patients identified as having undergone radical cystectomy for malignancy were interviewed within 6-24 months from the time of surgery and stratified by diversion type. Following written consent, interviews were conducted either in person or over the phone; all interviews were recorded. Interviews were conducted in a semi-structured manner by two urologists, with 9 open-ended questions and additional unscripted follow-up questions based on themes raised by the patients. The interviews were reviewed for common themes, preferences, and recommendations. RESULTS: A total of 13 interviews were conducted. No patient expressed decision regret about their choice of urinary diversion. 77% specifically stated that they had adequate information about diversion options pre-operatively. Those that did not express this were primarily disappointed by post-operative counseling, specifically for ostomy appliances, not pre-operative surgical counseling. The most striking recurrent theme was the desire for a “buddy system” in which patients could contact and maintain discussion with an experienced patient. The overall impression was that this system would be most useful in the recovery/maintenance phase rather than in the pre-operative decision-making process. 62% of patients reported this would have been the single biggest area for improvement in their experience, with only one patient stating he would not have opted to talk to a peer. Although 46% of patients expressed surprise about complications they experienced, none felt that this was secondary to inadequate pre-operative counseling or that these complications should have been discussed in more detail prior to the surgery. CONCLUSIONS: This data furnishes a basis to develop more accessible and effective patient centered decision making tools and highlights the need to concentrate on post-surgical maintenance care, including management of urostomy appliances, catheters and reinforcing irrigation technique. Future research should include repeating similar interviews at other centers, assessing responses to new post-operative care resources, and optimizing a system to co-ordinate a dynamic peer-peer network. Source of Funding: Grant from NIH/NCI under award number P30CA016672 and the Shared Decision Making Core. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e822-e823 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Geraldine Theresa Klein* More articles by this author Divya Ajay More articles by this author Robert Volk More articles by this author Viola Leal More articles by this author Vikram Narayan More articles by this author Ouida Lenaine Westney More articles by this author Expand All Advertisement PDF downloadLoading ...