Refined decision aid proves fruitful for patients with kidney masses
Comparing the performance of legacy patient information with that of a new, carefully developed patient decision aid (DA), researchers have found the latter significantly improves patients’ knowledge of a medical condition at hand.
In the scenario under review, the condition was small kidney masses.
That’s a fitting indication for radiological consideration since, as the researchers point out, complex renal cysts or solid renal masses appear in 13% to 27% of individuals who receive abdominal imaging.
On metrics for comprehension of shared decision-making processes, the DA—a print publication freshly imbued with evidence-based risk language, multidisciplinary input and guidance from a committee of experts—brought a mean score of 53% vs. 22% for the legacy material group.
Additionally, the DA lopsidedly boosted the proportion of patients discussing a fairly technical intervention, ablation (67% vs. 18%).
The aid further brought a positive return on investment regarding patients’ grasp of the pros and cons of various treatment options.
The study was conducted at New York University and published June 14 in JACR [1].
Decision Aids Can Help Clinicians Help Patients Who Don’t Know What They Don’t Know
Confoundingly, the authors report, patient satisfaction with the legacy institutional pamphlet rivaled that of the DA—“despite the [pamphlet] patients having less knowledge about their diagnosis and less thorough conversations with their providers.”
The latter finding, the authors suggest, indicates that “patients may not appreciate deficiencies in educational resources at the time of accessing care.”
Shailin Thomas, JD, Stella Kang, MD, and colleagues drafted the decision aid after reviewing the applicable literature and consulting with urologists, radiologists and an internist.
The team further convened two patient focus groups to ensure the aid’s user-friendliness.
Next they piloted the publication with 30 patients randomly selected to receive legacy patient material or the new DA at their initial appointment with a urologist.
Surveying the cohorts both before and after the urology consultation, the researchers found the DA yielding significant improvements vs. the existing material regarding patient knowledge about risks and treatments.
Other topics in which both groups of patients were informed were the risk of cancer spread during active surveillance and percutaneous ablation, the impact of chronic kidney diseases and other comorbidities, and the recovery period after both surgery and ablation.
Key findings included:
- Most patients said they found their radiology reports difficult to understand. “The results of that ultrasound were confusing to me, and I went online to look at what does this term mean, what does that term mean,” one patient said.
- Patient preferences on treatments varied between groups. Half of patients receiving the legacy material were undecided, and the other half favored surgery. Most DA patients preferred active surveillance with imaging (53%), followed by surgery (11%) and percutaneous ablation (5%), and the rest remained undecided.
- In both groups, most participants (90%) spent less than 30 minutes reviewing the materials with the majority of patients spending between 15 and 30 minutes. There were no significant differences in the review time between groups.
- With respect to feasibility of use in clinic, DA patients were significantly more likely to report looking at the entirety of the educational materials provided (84% versus 40%), and 100% of DA participants viewed at least part of the DA.
- DA patients demonstrated significantly better knowledge postintervention than legacy material patients (total scores 52.6% vs. 19%).
Confident Patients Meaningfully Participate in Shared Decision Making
The pilot evaluation “showed DA feasibility, given comparable patient satisfaction and higher rates of material review, and differences in patient knowledge about small kidney masses as well as important facets of management options compared with existing institutional material,” Thomas and co-authors comment. “Patients had a better understanding of the diagnosis after viewing the DA and were more likely to discuss all three treatment options, along with having had an explanation of benefits and risks associated with each option.”
More:
Compared with the [legacy] institutional material, more patients viewing the DA stated a precounseling treatment preference rather than being unsure, and more than half favored surveillance. These patients entered their urology appointments better prepared to discuss treatment options due to this background knowledge. DA use resulted in better sense of understanding whether the benefits were more important to the patient than risks or potential harms, but no other satisfaction measures were significantly different.
Overall, given the DA’s positive payoffs, the authors conclude that evidence-based patient decision aids “can ameliorate the deficiencies in current communication practices by providing patients comprehensive and critical information before treatment discussions, thereby improving patient understanding of their health and their treatment options.”
The authors call for larger studies to test the generalizability of their findings, an important question, they note, given known demographic disparities in outcomes of patients with renal masses and kidney disease.
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Reference:
- Shailin Thomas, JD, Stella Kang, MD, “Development and Pilot Evaluation of a Decision Aid for Small Kidney Masses.” Journal of the American College of Radiology, June 14, 2022. DOI: https://doi.org/10.1016/j.jacr.2022.05.017
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.