Presentation Authors: John Cabri*, Sylvia Lambrechts MPH MA, Matthew Pollard MD, Lorna Kwan MPH, Haoyue Zhang MPH, Adam Pena, Daniel Brownstein, Hui Liu MS, Jessica Chang, Juliana Alden, Nishant Patel MD, Matthew Dunn MD, Christopher Saigal MD, Los Angeles, CA
Introduction: Urolithiasis is a &[Prime]preference-sensitive&[Prime] condition with several treatment options. Shared decision-making research has found that optimal treatment can depend on identifying and incorporating a patients&[prime] values into decision making. This has reduced use of invasive elective procedures. We piloted a pre-consultation decision aid (DA) for patients diagnosed with urolithiasis to identify key patient values and to assess the impact of its use on treatment choice.
Methods: Patients seen in the urology clinic for newly diagnosed urolithiasis from March 2016 to May 2017 received usual care (UC). Starting June 2017, we piloted a DA completed by patients prior to their first consultation. The DA measured patient concerns for urolithiasis risks and benefits using conjoint analysis and produced a report that displayed the preference-weighted results. Following consultation, patients were administered a questionnaire that assessed their pre- and post-consultation treatment preferences.
Results: The top three concerns among patients who completed the DA and post-visit questionnaire (n=29) were &[Prime]major medical problem after surgery&[Prime] (83%); &[Prime]injury to your ureter&[Prime] (48%); &[Prime]post-treatment stone fragments clog up your ureter&[Prime] (41%); and &[Prime]treatment intensity&[Prime] (41%). DA patients were more likely than UC patients (n=78) to identify a treatment preference prior to consultation (76% vs. 42%, p < 0.01). The change in preferences from pre- to post-consultation was statistically significant only within the UC group (p < 0.01). Twice as many UC patients chose surgery from pre- to post-consultation (23% to 46%, p < 0.01), while the increase among DA patients (31% to 48%) was smaller and not statistically significant.
Conclusions: This pilot demonstrated the potential for a DA to identify concerns and facilitate treatment selection for patients with urolithiasis. The similar distribution of treatment preferences pre- and post- consultation for the DA group might be attributed to the DA aiding patients in making a pre-consultation treatment decision that did not change after consultation. The preference for surgery did not decrease in the DA group, which contrasts with DAs studied for other conditions. To date, this also describes the only pre-treatment measurement of the concerns important to patients diagnosed with urolithiasis. Highest among these were post-surgical complications.