Development and Pilot Evaluation of a Decision Aid for Small Kidney Masses

Thomas, Shailin; Siriruchatanon, Mutita; Albert, Stephanie L.; Bjurlin, Marc A.; Hoffmann, Jason C.; Langford, Aisha T.; Braithwaite, R. Scott; Makarov, Danil V.; Fagerlin, Angela; Kang, Seok Kwon

doi:10.1016/j.jacr.2022.05.017

Cited by 3 publications

(5 citation statements)

References 44 publications

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“…36 Shared decision-making involves collaborative evidence-based decisions aligned with patient preferences and priorities, and DAs have been designed to facilitate the process. 16 Yet, DAs for other diseases have produced mixed results with respect to decisional conflict and regret, not to mention treatment selection and outcomes. 16,17,37 In practice, shared decision-making requires physicians to draw upon their clinical acumen to tailor evidence and communicate information in a manner that patients can digest.…”

Section: Discussionmentioning

confidence: 99%

“…16 Yet, DAs for other diseases have produced mixed results with respect to decisional conflict and regret, not to mention treatment selection and outcomes. 16,17,37 In practice, shared decision-making requires physicians to draw upon their clinical acumen to tailor evidence and communicate information in a manner that patients can digest. This study helps elucidate the potential areas in which effective communicators have intuitively homed in on and DAs could purposely act upon to facilitate information processing for patients.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated decisional conflict has also been associated with worse quality of life. 12,15 In response to this challenge, decision aids (DAs) and shared decision-making have been recommended and developed, 16,17 but their effectiveness depends on a clear understanding of both the factors in decision-making and the specific decision support needs of patients. Prior research has been conducted to identify drivers of treatment decision-making including kidney cancer-specific, clinician, and contextual factors (eg, age, comorbidities, tumor size/ complexity, geography, practice patterns).…”

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confidence: 99%

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Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: A Prospective Study

Feinberg,

Gessner,

Deal

et al. 2024

Journal of Urology

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Purpose: Because multiple management options exist for clinical T1 renal masses, patients may experience a state of uncertainty about the course of action to pursue (ie, decisional conflict). To better support patients, we examined patient, clinical, and decision-making factors associated with decisional conflict among patients newly diagnosed with clinical T1 renal masses suspicious for kidney cancer. Materials and Methods: From a prospective clinical trial, participants completed the Decisional Conflict Scale (DCS), scored 0 to 100 with < 25 associated with implementing decisions, at 2 time points during the initial decision-making period. The trial further characterized patient demographics, health status, tumor burden, and patient-centered communication, while a subcohort

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: A Prospective Study

Feinberg,

Gessner,

Deal

et al. 2024

Journal of Urology

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“…Initial usability testing in phase 2 informed an estimated review time of the given materials in under 30 minutes [ 17 ]. Patients who received the DA were more likely to self-report reviewing the DA completely than those who received the standard pamphlet [ 17 ], supporting the likelihood of viewing the web version of the tool, indicating that the DA is easily accessible to most populations and is not expected to be burdensome.…”

Section: Discussionmentioning

confidence: 99%

“…The web-based DA tool delivers information regarding SKMs, treatment options, and preparation for shared decisions to improve patient knowledge and provide tailored treatment options based on patient information. With the additional web-based graphics and values clarification, the tool may further improve upon initial findings that the booklet form of the DA resulted in more accurate understanding of risks associated with SKMs and each treatment option, and greater preference for nonsurgical initial approaches as compared to patients who received existing institutional educational materials [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

An Evaluation of a Web-Based Decision Aid for Treatment Planning of Small Kidney Tumors: Pilot Randomized Controlled Trial

Fogarty¹,

Siriruchatonon²,

Makarov³

et al. 2022

JMIR Res Protoc

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Background Surgery is the most common treatment for localized small kidney masses (SKMs) up to 4 cm, despite a lack of evidence for improved overall survival. Nonsurgical management options are gaining recognition, as evidence supports the indolence of most SKMs. Decision aids (DAs) have been shown to improve patient comprehension of the trade-offs of treatment options and overall decision quality, and may improve consideration of all major options according to individual health priorities and preferences. Objective This pilot randomized controlled trial (RCT) primarily aims to evaluate the impact of a new web-based DA on treatment decisions for patients with SKM; that is, selection of surgical versus nonsurgical treatment options. Secondary objectives include an assessment of decision-making outcomes: decisional conflict, decision satisfaction, and an understanding of individual preferences for treatment that incorporate the trade-offs associated with surgical versus nonsurgical interventions. Methods Three phases comprise the construction and evaluation of a new web-based DA on SKM treatment. In phase 1, this DA was developed in print format through a multidisciplinary design committee incorporating patient focus groups. Phase 2 was an observational study on patient knowledge and decision-making measures after randomization to receive the printed DA or institutional educational materials, which identified further educational needs applied to a web-based DA. Phase 3 will preliminarily evaluate the web-based DA: in a pilot RCT, 50 adults diagnosed with SKMs will receive the web-based DA or an existing web-based institutional website at urology clinics at a large academic medical center. The web-based DA applies risk communication and information about diagnosis and treatment options, elicits preferences regarding treatment options, and provides a set of options to consider with their doctor based on a decision-analytic model of benefits/harm analysis that accounts for comorbidity, age group, and tumor features. Questionnaires and treatment decision data will be gathered before and after viewing the educational material. Results This phase will consist of a pilot RCT from August 2022 to January 2023 to establish feasibility and preliminarily evaluate decision outcomes. Previous study phases from 2018 to 2020 supported the feasibility of providing the printed DA in urology clinics before clinical consultation and demonstrated increased patient knowledge about the diagnosis and treatment options and greater likelihood of favoring nonsurgical treatment just before consultation. This study was funded by the National Cancer Institute. Recruitment will begin in August 2022. Conclusions A web-based DA has been designed to address educational needs for patients making treatment decisions for SKM, accounting for comorbidities and treatment-related benefits and risks. Outcomes from the pilot trial will evaluate the potential of a web-based DA in personalizing treatment decisions and in helping patients weigh attributes of surgical versus nonsurgical treatment options for their SKMs. Trial Registration ClinicalTrials.gov NCT05387863; https://clinicaltrials.gov/ct2/show/NCT05387863 International Registered Report Identifier (IRRID) PRR1-10.2196/41451

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Development and validation of a multicenter Cox regression model to predict all-cause mortality in patients with renal masses suspicious for renal cancer

Lane,

Cheaib,

Boynton

et al. 2024

Urologic Oncology: Seminars and Original Investigations

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Development and Pilot Evaluation of a Decision Aid for Small Kidney Masses

Cited by 3 publications

References 44 publications

Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: A Prospective Study

Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: A Prospective Study

An Evaluation of a Web-Based Decision Aid for Treatment Planning of Small Kidney Tumors: Pilot Randomized Controlled Trial

Development and validation of a multicenter Cox regression model to predict all-cause mortality in patients with renal masses suspicious for renal cancer

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