Presentation Authors: Daniel Brownstein*, Sylvia Lambrechts, Matthew Dunn, Chris Saigal, Nishant Patel, Los Angeles, CA
Introduction: Shared decision making (SDM) is a collaborative process between a patient and physician to arrive at a treatment decision. Decision aids (DA) are educational interventions to facilitate efficient SDM, but DAs must address patients&[prime] key concerns for effectiveness. Qualitative research helps to identify information required for high quality decisions, but such research is lacking in the study of nephrolithiasis. We therefore sought to perform a qualitative analysis of SDM in kidney stone patients.
Methods: Patients at an academic medical center who completed an existing decisional aid, WiserCare, participated in a 30-minute structured interview following their consult with a urologist. The interview consisted of 11 items that examined the patients&[prime] decision process. Interviews were transcribed and parsed into individual quotes. We then identified themes and assigned quotes to them utilizing the content analysis framework. Patients&[prime] final treatment decisions were compared to results from a decision analysis generated by the WiserCare DA, and differences in themes were identified between patients who made concordant and discordant treatment choices.
Results: 11 patients completed the decision aid and structured interview. The most important decision making factors highlighted by patients were the risk of complications (9), ability of treatment to make a patient stone free (9), recovery time (8), and deferring to physician recommendation (6). Patients&[prime] sources of information included physicians (9), prior experiences with stone disease (8), and family/friends (5). 7 patients identified prevention of future stone recurrence as a long-term goal. 5 patients chose treatments that were concordant with their preferences as identified by the DA and 6 chose treatment options that were discordant. Patients with concordant choices were more likely to identify relief of symptoms as a factor (5) and family and friends as a source of information (4). Patients with discordant choices were more likely to value stone free rates (5).
Conclusions: Important elements in SDM for kidney stone management include the risk of treatment complications and receiving definitive treatment. Patients tend to rely on prior experiences and provider recommendation. These data can be used to improve our SDM program for kidney stone formers.