Improved Shared Decision-making for Patients with Renal Cell Carcinoma: Results of the SDM-RCC Study

AbstractBackground and objective To improve shared decision-making (SDM) for renal cell carcinoma (RCC), we implemented an SDM intervention consisting of a patient decision aid and health care professional (HCP) training. This study evaluates its effectiveness. Design, setting, and parcticipants Multicenter prospective pretest–post-test study including adults with localized RCC or metastatic clear cell RCC. The pretest group received standard care; the post-test group was included after SDM intervention implementation. Outcome measurement and statistical analysis The primary outcome was the Observing Patient Involvement in Decision-making (OPTION)-5 score, measuring patient involvement. Secondary outcomes included HCP- and patient-reported SDM and decision quality (eg, Decisional Conflict Scale DCS, Control Preference Scale CPS). Exploratory outcomes were quality of life, quality of the decision-making process (ie, Assessing Communication about Evidence and Patient Preferences ACEPP subscale 1A), and process indicators (eg, treatment decision). Mixed-effects regression model with random intercepts for hospital was used. Results and limitations Post-test, OPTION-5 scores increased significantly (47.2–60.5; mean difference 13.2; 95% CI 8.7–17.8; p 0.001), with improvements across most hospitals and all OPTION-5 items. HCP-reported SDM and ACEPP subscale 1A also increased (both p 0.001), while patient-reported SDM remained unchanged. The number and duration of consultations increased, and DCS uncertainty scores showed more conflict, while the CPS remained unchanged. The pretest–post-test design minimized inter-hospital workflow variation and supported sustained behavioral change but limits causal inference. Conclusions Implementation of an SDM intervention was significantly associated with observed and HCP-reported SDM, while patient-perceived involvement remained similar. These findings suggest integrating the SDM intervention into routine RCC care to promote patient-centered decision-making.