Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses

No AccessJournal of UrologyAdult Urology8 May 2024Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses Amir Feinberg, Kathryn H. Gessner, Allison M. Deal, Hillary Heiling, Shannon Myers, Mathew C. Raynor, Matthew I. Milowsky, Sara E. Wobker, Clayton Commander, Allison J. Lazard, Marc A. Bjurlin, Angela B. Smith, David C. Johnson, Eric M. Wallen, William Y. Kim, and Hung-Jui Tan Amir FeinbergAmir Feinberg https://orcid.org/0000-0002-0688-8077 , Kathryn H. GessnerKathryn H. Gessner , Allison M. DealAllison M. Deal , Hillary HeilingHillary Heiling , Shannon MyersShannon Myers , Mathew C. RaynorMathew C. Raynor , Matthew I. MilowskyMatthew I. Milowsky , Sara E. WobkerSara E. Wobker , Clayton CommanderClayton Commander , Allison J. LazardAllison J. Lazard , Marc A. BjurlinMarc A. Bjurlin , Angela B. SmithAngela B. Smith , David C. JohnsonDavid C. Johnson , Eric M. WallenEric M. Wallen , William Y. KimWilliam Y. Kim , and Hung-Jui TanHung-Jui Tan Corresponding Author: Hung-Jui Tan, MD, MSHPM, Department of Urology, University of North Carolina, Chapel Hill, 2116 Physician Office Building, Campus Box 7235, Chapel Hill, NC 27599-7235 ( (email protected) ). View All Author Informationhttps://doi.org/10.1097/JU.0000000000004023AboutPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract 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 two timepoints during the initial decision-making period. The trial further characterized patient demographics, health status, tumor burden, and patient-centered communication while a sub-cohort completed additional questionnaires on decision-making. Associations of patient, clinical, and decision-making factors with DCS scores were evaluated using generalized estimating equations to account for repeated measures per patient. Results: Of 274 enrollees, 250 completed a DCS survey; 74% had masses ≤ 4 cm in size while 11% had high complexity tumors. Model-based estimated mean DCS score across both timepoints was 17.6 (95% CI: 16.0-19.3) though 50% reported a DCS score ≥ 25 at least once. On multivariable analysis, DCS scores increased with age (+2.64, 95% CI 1.04-4.23), high vs low complexity tumors (+6.50, 95% CI 0.35-12.65), and cystic vs solid masses (+9.78, 95% CI 5.27-14.28). Among decision-making factors, DCS scores decreased with higher self-efficacy (−3.31, 95% CI −5.77 to −0.86]) and information-seeking behavior (−4.44, 95% CI −7.32 to −1.56). DCS scores decreased with higher patient-centered communication scores (−8.89, 95% CI −11.85 to −5.94). Conclusions: In addition to patient and clinical factors, decision-making factors and patient-centered communication relate with decisional conflict, highlighting potential avenues to better support patient decision-making for clinical T1 renal masses. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsearly-stage kidney cancersmall renal massesmedical decision-makingdecisional conflictMetrics Author Information Amir Feinberg More articles by this author Kathryn H. Gessner More articles by this author Allison M. Deal More articles by this author Hillary Heiling More articles by this author Shannon Myers More articles by this author Mathew C. Raynor More articles by this author Matthew I. Milowsky More articles by this author Sara E. Wobker More articles by this author Clayton Commander More articles by this author Allison J. Lazard More articles by this author Marc A. Bjurlin More articles by this author Angela B. Smith More articles by this author David C. Johnson More articles by this author Eric M. Wallen More articles by this author William Y. Kim More articles by this author Hung-Jui Tan Corresponding Author: Hung-Jui Tan, MD, MSHPM, Department of Urology, University of North Carolina, Chapel Hill, 2116 Physician Office Building, Campus Box 7235, Chapel Hill, NC 27599-7235 ( (email protected) ). More articles by this author Expand All Advertisement PDF downloadLoading ...