Category: Clinical Stones: Medical Management

MP10-13 - How Do Patients' Perceptions of Their Kidney Stones Affect Their Confidence in Treatment to Control Stones and Their Urinary Stone Risk?

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : Patients’ perceptions of their stone disease may predict their responses to treatment and could be used to enhance health-related decision-making. We assessed patients’ perceptions of their stones using the validated Illness Perception Questionnaire (IPQ).

Methods : Adults from urology clinic were mailed or provided the IPQ shortly before or at a clinic appointment. This study was deemed exempt from requiring human subjects research approval by the local IRB. The revised IPQ provides quantitative operationalization of the common-sense self-regulation model, a framework used to explain patients’ health-related behavior. We modified the IPQ to refer to “kidney stones” (as IPQ authors suggest) in all 38 items, which were related to disease consequences, sense of personal control (PC), confidence in treatment (CT), disease coherence, and emotional representations (ER). Descriptive statistics were compiled; comparisons to 24-h urine results were made.

Results :

Respondents (n=148) were 58±14 y (range 21-86 y), 58% male, 96% Caucasian, and largely calcium stone formers. The majority (82%) cited diet as a cause of their stones; other causes cited were hereditary (49%), “my own behavior” (47%), “bad luck” (21%), and aging (20%). Patients’ sense of PC over their stones was directly correlated with TC (R=0.69). Disease consequences (symptoms, burden) correlated with ER (R=0.43), and ER correlated inversely with coherence of (knowledge about) stone disease (R=-0.37). Patients with higher knowledge about stones had a greater sense of PC (P=0.0008) and fewer emotional consequences (P=0.001). Patients >65 years had a higher sense of PC and TC than younger patients (P<0.02). Interestingly, there were no notable gender differences except that women reported worse effects related to the chronic/cyclical nature of their stones. Patients with greater TC had higher urine output in 24-h urine collection (2.4±0.78 vs. 1.9±0.69 L/d, P=0.0004).

Conclusions : Our results suggest that patients’ knowledge about stone disease may influence their sense of control over their stones which, in turn, influences their confidence in treatment. Greater understanding of stone disease may thus foster personal control and confidence in treatment, the latter of which was strongly associated with higher urine output in our study.

Kristina L. Penniston

Senior Scientist
University of Wisconsin School of Medicine and Public Health, Department of Urology
Madison, Wisconsin

Kristina Penniston is a scientist and registered dietitian nutritionist in Madison, Wisconsin. Dr. Penniston earned her PhD in nutritional science from the University of Wisconsin-Madison. She completed a dietetic internship at the University of Wisconsin Hospital and Clinics and is a certified dietitian member and fellow of the Academy of Nutrition and Dietetics. Dr. Penniston has provided clinical nutrition services to patients with kidney stones and other urologic diseases, such as urologic cancer and benign urologic conditions, for 20 years. Dr. Penniston's research in the Department of Urology at the University of Wisconsin School of Medicine and Public Health focuses on prevention of kidney stones. Specifically, her research aims to develop and test dietary interventions that prevent or ameliorate recurrent stones; promote patients' self-efficacy in managing their stone disease; and understand and improve patients’ health-related quality of life. Dr. Penniston has developed a porcine model of dietary-induced calcium oxalate urolithiasis as a platform for studying dietary influences on stone formation. She also helped to develop the Wisconsin Stone Quality of Life questionnaire, a stone-specific instrument to assess patients' health-related quality of life. Dr. Penniston is a member of the American Urological Association and is a former research scholar (2008-2010). She has been a member of the Research on Calculus Kinetics (ROCK) Society since 2008 and was elected in 2018 as secretary/treasurer. Dr. Penniston publishes regularly in urologic and nutrition journals.

R. Allan Jhagroo

Associate Professor
University of Wisconsin School of Medicine and Public Health, Department of Medicine
Madison, Wisconsin

Stephen Y. Nakada

University of Wisconsin School of Medicine and Public Health, Department of Urology
Madison, Wisconsin

Stephen Y. Nakada, MD, FACS is Professor and founding Chairman of the Department of Urology and the David T. Uehling Chair of Urology at the University of Wisconsin School of Medicine and Public Health in Madison, WI. He received his medical degree from the University of Rochester School of Medicine and Dentistry, and completed his residency training at Strong Memorial Hospital in Rochester, NY. Dr. Nakada went on to complete his Endourology Fellowship at Washington University prior to joining the faculty at the University of Wisconsin in 1995. Dr. Nakada has been the Chairman of Urology in Madison since 2001.

Dr. Nakada's research focuses on urolithiasis and renal aspects of minimally invasive urology. He has authored or co-authored over 200 scientific articles, 50 book chapters, and he has edited more than 10 textbooks in those areas. In 2004, Dr. Nakada received the Gold Cystoscope Award and in 2017 he received the Distinguished Service Award from the AUA. He is currently an editorial consultant for Urology Times and an Assistant Editor of the Journal of Endourology.

Dr. Nakada has served as President of the R.O.C.K. Society, Society of Academic Urologists and the Endourological Society. He has served on the AUA Staghorn Stone and Ureteral Stones Guidelines Committees, the AUA/ABU Examination Committee, and he served as the Chair of the AUA Laparoscopy & Robotic Surgery Committee. Currently, Dr. Nakada is President of the American Board of Urology and a member of the Advisory Council in Urology to the American College of Surgeons. Dr. Nakada is an active member of the American Association of Genitourinary Surgeons and the Clinical Society of Genitourinary Surgeons, among other societies.