Best Practices & Benign Disease
Introduction & Objective: The finding of small renal mass (SRM) on radiological imaging and the potential of a cancer diagnosis is anxiety provoking for most patients. When diagnosed with a SRM, patients are confronted with multiple treatment options forcing a decision on a therapeutic course. The decision-making process often occurs in the absence of any framework to guide patients. The purpose of this initiative was to develop and implement a shared-decision-making (SDM) model for newly diagnosed patients. Specific goals of the SDM model were to improve patient knowledge, alleviate patient anxiety, and improve patient confidence to make evidence-based decisions.
Methods: A SDM model was developed and implemented utilizing an educational video [Urology Care Foundation’s “What is a renal mass?” video] and a structured provider discussion. Patient knowledge, anxiety, and confidence in decision-making was assessed using a pre- and post-intervention survey. Structured provider discussions included risks and benefits of each management strategy individualized to the patient’s situation. Initial preference, informed preference and final treatment decision were recorded for each patient.
Results: Thirty-four participants demonstrated improved knowledge with a mean of 1.8, 4 were unchanged, 2 decreased. A Wilcoxon signed rank test was used for data analysis, P value <0.001; 1.8, CI of 95% (1.5-2.9) validated a significant improvement in knowledge post intervention. Two questions pertained to patient's self-assessment of anxiety and confidence in decision-making. Approximately 40% of patients reported a decrease in their anxiety rating by a mean of 39%. When confidence in decision-making improved, it improved by a mean of 38%.
Conclusions: There was clear trend towards a greater patient understanding of SRMs. A SDM model which incorporated an intervention (educational video and structured provider discussion) showed improved patient knowledge, alleviation of anxiety and improved confidence in decision-making. The findings demonstrate the feasibility of implementing a SDM model with newly diagnosed patients. Results should encourage providers who aspire to incorporate a SDM model as a Best Practice for educating and counseling all such patients.