Mp12-17 Understanding Patient Decision-Making for Clinical T1 Renal Masses

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (MP12)1 May 2024MP12-17 UNDERSTANDING PATIENT DECISION-MAKING FOR CLINICAL T1 RENAL MASSES Katherine E. Poulos, Allison Lazard, Lixin Song, Kathryn H. Gessner, Amir Feinberg, Deborah Usinger, Randall Teal, Debra Gottsleben, Marc Bjurlin, Eric Wallen, David Johnson, Mathew C. Raynor, and Hung-Jui Tan Katherine E. PoulosKatherine E. Poulos , Allison LazardAllison Lazard , Lixin SongLixin Song , Kathryn H. GessnerKathryn H. Gessner , Amir FeinbergAmir Feinberg , Deborah UsingerDeborah Usinger , Randall TealRandall Teal , Debra GottslebenDebra Gottsleben , Marc BjurlinMarc Bjurlin , Eric WallenEric Wallen , David JohnsonDavid Johnson , Mathew C. RaynorMathew C. Raynor , and Hung-Jui TanHung-Jui Tan View All Author Informationhttps://doi.org/10.1097/01.JU.0001009376.16371.fb.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients diagnosed with clinical T1 renal masses have multiple treatment options, especially those with a small renal mass (SRM). While numerous studies have examined clinical determinants of treatment choice, the patient perspective on treatment selection remains grossly understudied despite calls for shared decision-making. Accordingly, we sought to explore the decision-making process and experience in this patient population. METHODS: We purposefully recruited 40 participants from GRADE-SRM, a prospective clinical trial studying the impact of renal mass biopsy on decision-making, based on high (21) vs. low (19) levels of decisional conflict for interviews. Trained qualitative researchers asked participants about their decision-making experience including factors that affected their management choice. Using a coding-based approach, we identified themes related to the overlying process and facilitators and barriers of treatment selection. RESULTS: Of the 40 participants, mean age was 65.1, 27.5% were non-White, and 42% were female. Patients gave five primary reasons for selecting a treatment, with the majority describing the treatment was recommended by the urologist (N=14) or only one treatment was recommended (N=12) with other primary reasons being progressively less represented (Figure 1). Of the four primary options to consider, participants reported diverse facilitators and barriers behind their selection. Across all options, selection of treatment largely revolved around patients' perception of surgeon recommendation and communication. Barriers for choosing active surveillance (AS) and biopsy often involved fear and anxiety. Barriers for AS often revolved around anxiety and fear of living with a mass or desire to resolve treatment rather than prolong care. Uniquely, many patients who chose biopsy felt it was minimally invasive or could give confirmatory information, while other patients chose against biopsy because they felt uncomfortable due to negative past experiences. CONCLUSIONS: For patients, surgeon recommendation and the options provided largely shape treatment choice. In particular, patients may be more amendable to biopsy or active surveillance if their fears and concerns were alleviated. To improve decision-making, efforts may need to be directed toward these points. Download PPT Source of Funding: This work was supported by funding from the Department of Defense © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e207 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Katherine E. Poulos More articles by this author Allison Lazard More articles by this author Lixin Song More articles by this author Kathryn H. Gessner More articles by this author Amir Feinberg More articles by this author Deborah Usinger More articles by this author Randall Teal More articles by this author Debra Gottsleben More articles by this author Marc Bjurlin More articles by this author Eric Wallen More articles by this author David Johnson More articles by this author Mathew C. Raynor More articles by this author Hung-Jui Tan More articles by this author Expand All Advertisement PDF downloadLoading ...