Gokce Mİ. et al., 2019: The role of a novel decision aid to support informed decision making process in patients with a symptomatic non - lower pole renal stone
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
OBJECTIVES: To evaluate the efficacy of a novel decision aid (DA) in improving the patients' level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone < 2 cm. MATERIALS AND METHODS: In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge. RESULTS: Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge. CONCLUSIONS: In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone < 20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.
Int Braz J Urol. 2018 Jun 15;44. doi: 10.1590/S1677-5538.IBJU.2018.0198. [Epub ahead of print]. FREE ARTICLE
The patient chooses the therapeutic procedure. To be able to do so, he must be well informed and understand his diagnosis, the therapeutic options and the consequences. The better the patients were or felt to be informed the more often they choose ESWL: “After the patient informing process, 20 of 57 (35.1%) patients of the patients in group 1 and 28 of the 58 (48.3%) of the patients in group 2 de¬cided to undergo SWL (p = 0.15).” This is different from todays frequency of ESWL and URS treatments! Waht should be gould to know is hwo the patients felt after therapy.
The complementary material to their first publication in the J Endourology (1) is a one-page information sheath for the patient. Half of the text explains the two procedures ESWL and URS. It basically is what you have to explain to the patient to get informed consent from him. The 12-pages EAU patient information material is available for everybody: https://patients.uroweb.org/wp-content/uploads/2018/12/10-April-2018_Stones.pdf.
1 Gökce MI et al. A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone