CUA 2018: Development of a Patient Decision Aid for Complex, Localized Renal Masses

Halifax, Nova Scotia ( One particularly challenging aspect of quality patient care is the allowance of the patient to make their own informed decisions regarding their care. The problem therein lies in the gap in understanding between the patient and physician’s perception of risk stratification. In particular, in regard to kidney cancer, the decision between radical versus partial nephrectomy remains a debated decision in urology for localized renal masses. Therefore, Dr. Kristen McAlpine and her team of urologists at the University of Ottawa attempted to develop a decision aid for patients with localized renal masses deciding on a proper surgical approach. 

In order to develop this particular aid, the International Patient Decision Aids Standards (IPDAS) and Ottawa Decision Support Frameworks were consulted, then a literature review with consensus on data was undertaken to identify the best procedures to inform patients. With the help of a steering team of content and process experts, the center was able to devise a draft for patient aid regarding their options and outcomes. After implementation of this draft, alpha testing occurred in urologists, patients (who previously underwent surgery), and advocates with a survey based questionnaire. Perioperative outcomes were explored for four treatment options: radical nephrectomy, open partial nephrectomy, laparoscopic partial nephrectomy, and active surveillance. The aid draft itself limited its scope to assist patients who have a challenging, localized renal mass and are deciding between surgical approach. Evidence-based outcomes regarding benefits, harms, and perioperative course were established, see image below for a summary of outcomes. Finally, questions were included on the aid to help drive the patient’s decision-making process due to their opinions, values, and preferences.  
Following the completion of the study, all 6 defining IPDAS criteria, all 6 certification criteria, and 20 of 23 quality criteria were met with the drafted patient aid. Following alpha testing, 11 urologists, 7 patients previous receiving surgery, 3 patient advocates, and 1 methodological expert reviewed the aid and answered the quality survey. A vast majority of total members agreed that the language was easy to follow, had appropriate length, balanced presentation of options, high-quality decisional tool, and useful tool for new patients. Particularly, the aid’s strengths were the simple language, graphics, and concept. 

At the conclusion of her presentation, Dr. McAlpine discussed that this type of decision aid should be implemented at all practicing urology fields. There was a high satisfaction in this study’s sample size and the concept could be easily expanded to other fields. In future studies, however, a randomized control trial and decision aid for patients with small renal masses should be carried out. 

Presented by: Kristen McAlpine, Division of Urology, University of Ottawa, Ottawa, ON, Canada

Co-Authors: Rodney Breau1,2, Dawn Stacey2, Christopher Knee1,2, Luke Lavallee1,2
1Division of Urology, University of Ottawa, Ottawa, ON, Canada; 2The Ottawa Hospital Research Institute, Ottawa, ON, Canada

Written by: Zachary Valley, MD, twitter: @ZacharyAValley), (Department of Urology, University of California-Irvine) at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia