Walters A. et al., 2021: Decision-Making, Preference, and Treatment Choice for Asymptomatic Renal Stones-Balancing Benefit and Risk of Observation and Surgical Intervention: A Real-World Survey Using Social Media Platform.
Walters A, Massella V, Pietropaolo A, Seoane LM, Somani B.J.
Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Department of Urology, Complexo Hospitalario Universitario de Ourense, Orense, Spain.
Introduction: The burden of kidney stone disease has risen, and several treatment options now exist. We wanted to evaluate the preference and treatment choices based on the information provided for management of hypothetical 8 and 15 mm renal stone, and factors that influenced their decision.
Materials and Methods: An online questionnaire to investigate trends in decision-making for two hypothesized scenarios of asymptomatic kidney stones (8 and 15 mm) was formatted online in Microsoft Forms and posted on social media (Facebook) in Europe. The ethical approval was obtained from the University Ethics Committee, and data were collected from general public between September and November 2020.
Results: A total of 476 participants of different age and background answered the survey with a male:female ratio of 1:2.7. The age groups were categorized as 18–25 years (n = 149), 26–49 years (n = 192), and 50+ years (n = 135). In the 8 mm scenario, 107 of the 476 participants (22.5%) chose observation, 249 (52.3%) chose extracorporeal shockwave lithotripsy (SWL) and 120 (25.2%) opted for ureteroscopy (URS). In the 15 mm scenario, 194 participants chose SWL treatment (40.8%), 216 (45.4%) URS, and 66 (13.9%) preferred percutaneous nephrolithotomy. The influencing factors were success rate, complication risk and invasiveness of the procedure. On comparison to 8 mm stone, while stent avoidance and activity limitation were considered less important with 15 mm stone ( p < 0.001), complication rates were considered more important ( p < 0.001).
Conclusion: More than one treatment choice for kidney stones often exists and clinicians must take patient choice into account via an informed decision-making process. While some might accept a higher risk of invasiveness and complications for higher stone-free rate, others might have a more conservative approach to this. It is about time that urologists take patient priorities and concerns into account and perhaps use Patient Reported Outcome Measures in addition to clinical outcomes when comparing treatment success.
Journal of Endourology 2021 Dec 9. doi: 10.1089/end.2021.0677. Online ahead of print. PMID: 34806905
“In this study, we wanted to evaluate the preference and treatment choices that the public would make based on the information provided for management of a hypothetical 8 and
15mm stone in the kidney and the factors that influenced their decision.”
Why did 476 unselected people seeing a questionnaire on urinary stone treatment popping up on their Facebook account take the time to work on it? Did they not have some other interesting things in life to be busy with? Are they representative for the “public”? Were these former stone patients and thus not representative for the “public”?
Why would their answers keep with the most recent British National Institute of Health and Care Excellence (NICE) guideline recommendations? In an older questionnaire study (1) referenced ”56.4% of patients - an experienced public - deferred the decision of the treatment approach to the physician.”
Did the 476 people answering really have a choice or were they unconsciously guided by the questions and information?
One advantage of the present publication is the collection of references dealing with patient-reported outcome measures (PROMs) which is becoming increasingly important for decision making in medicin.
1 Sarkissian C, Noble M, Li J, et al. Patient decision making for asymptomatic renal calculi: Balancing benefit and risk. Urology 2013;81:236–240.