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Dibianco JM. et al., 2022: Development of a surgical decision aid for patients with nephrolithiasis: Shockwave lithotripsy versus ureteroscopy.

Dibianco JM, Conrado B, Daignault S, Hawley S, Lane G, Wenzler D, Seifman B, Phelps J, Cotant M, Ghani KR, Dauw CA.
Department of Urology, University of Florida, Gainesville, Florida, USA.
Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Comprehensive Urology, Novi, Michigan, USA.
Michigan Institute of Urology, West Bloomfield Township, Michigan, USA.
West Shore Urology, Muskegon, Michigan, USA.£

Abstract

Introduction and Objective: Shared decision making is recommended to guide medical/surgical treatment strategies. We aimed at developing a surgical decision aid (SDA) facilitating decision making between ureteroscopy (URS) or shockwave lithotripsy (SWL) in patients with symptomatic nephrolithiasis. Methods: The SDA scope was identified through discussions with patients and urologists in the Michigan Urological Surgery Improvement Collaborative (MUSIC). A steering committee of patient advocates, MUSIC coordinating center, content experts, biostatisticians, and urologists was formed. Content domains were assessed through best available evidence and content experts. For content validation we anonymously surveyed 35 MUSIC urologists. Content validity ratios (CVR), numeric value indicating degree of expert validity, were calculated. Face validation interviews were conducted with patient advocates. Results: The SDA prototype using descriptive plain language and pictorial information was designed for nephrolithiasis patients, candidates for SWL or URS. It first provides patients procedural education whereas the second section informs urologists of patient goals. Six content domains were chosen: anesthesia type, effectiveness, number of procedures, risk, pain, and recovery. Overall, 91.4% and 85.7% of MUSIC urologists indicated that each section accomplished their goals, respectively. Anesthesia received an unacceptable CVR. High levels of face validation overall were reported with unacceptable scoring for anesthesia and recovery. Conclusions: We developed an SDA facilitating treatment choice between SWL and URS with promising content and face validity. Agreement and contradiction between anesthesia type and recovery validation results indicate the importance of shared decision making and the need for a validated SDA. Future work should focus on the SDAs value and opportunities for refinement in practice.
J Endourol. 2022 Oct 3. doi: 10.1089/end.2022.0494. Online ahead of print. PMID: 36193563

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Comments 1

Hans-Göran Tiselius on Wednesday, 15 March 2023 09:30

The authors developed a booklet with information on URS and SWL for the Michigan Urological Surgery Improvement Collaborative. The aim was to provide information on these two treatment modalities and facilitate the shared decision. The different points to which attention was paid were:

Type of anesthesia
Treatment effectiveness
Number of treatment procedures
Risk
Pain
Recovery

The authors emphasize that, in the decision process, it was important to include aspects that were of relevance for both patients and urologists.

Although it is claimed that URS requires anesthesia while SWL does not, it is surprising that patients considered anesthesia as a factor of less importance. Equally surprising is it that recovery time was deemed unimportant by the patients! Although both factors obviously were of low relevance for patients as well as urologists, they are not irrelevant for the cost of the procedures. It is possible that economic aspects are of limited importance for urologists in the Michigan area and it is understood that these two factors accordingly were excluded from the information in the booklet. This step might, however, be a doubtful decision because economic factors related to treatment and recovery can vary individually between patients as well as for the health economy in general.

There was no distinction between treatment aspects of ureteral and kidney stones.

There is limited information on how the shared decision corresponded to patients’ experience of the treatment. Nevertheless, it is the reviewer’s opinion that careful patient information is of utmost importance.

Hans-Göran Tiselius

The authors developed a booklet with information on URS and SWL for the Michigan Urological Surgery Improvement Collaborative. The aim was to provide information on these two treatment modalities and facilitate the shared decision. The different points to which attention was paid were: Type of anesthesia Treatment effectiveness Number of treatment procedures Risk Pain Recovery The authors emphasize that, in the decision process, it was important to include aspects that were of relevance for both patients and urologists. Although it is claimed that URS requires anesthesia while SWL does not, it is surprising that patients considered anesthesia as a factor of less importance. Equally surprising is it that recovery time was deemed unimportant by the patients! Although both factors obviously were of low relevance for patients as well as urologists, they are not irrelevant for the cost of the procedures. It is possible that economic aspects are of limited importance for urologists in the Michigan area and it is understood that these two factors accordingly were excluded from the information in the booklet. This step might, however, be a doubtful decision because economic factors related to treatment and recovery can vary individually between patients as well as for the health economy in general. There was no distinction between treatment aspects of ureteral and kidney stones. There is limited information on how the shared decision corresponded to patients’ experience of the treatment. Nevertheless, it is the reviewer’s opinion that careful patient information is of utmost importance. Hans-Göran Tiselius
Monday, 17 June 2024