NYU Grossman School of Medicine, New York, New York.
Department of Radiology, NYU Grossman School of Medicine, New York, New York.
J Am Coll Radiol. 2022 Aug;19(8):935-944. doi: 10.1016/j.jacr.2022.05.017. Epub 2022 Jun 15.
To develop and pilot test a patient decision aid (DA) describing small kidney masses and risks and benefits of treatment for the masses.
An expert committee iteratively designed a small kidney mass DA, incorporating evidence-based risk communication and informational needs for treatment options and shared decision-making. After literature review and drafting content with the feedback of urologists, radiologists, and an internist, a rapid qualitative assessment was conducted using two patient focus groups to inform user-centered design. In a pilot study, 30 patients were randomized at the initial urologic consultation to receive the DA or existing institutional patient educational material (PEM). Preconsultation questionnaires captured patient knowledge and shared decision-making preferences. After review of the DA and subsequent clinician consultation, patients completed questionnaires on discussion content and satisfaction. Proportions between arms were compared using Fisher exact tests, and decision measures were compared using Mann-Whitney tests.
Patient informational needs included risk of tumor growth during active surveillance and ablation, significance of comorbidities, and posttreatment recovery. For the DA, 84% of patients viewed all content, and mean viewing time was 20 min. Significant improvements in knowledge about small mass risks and treatments were observed (mean total scores: 52.6% DA versus 22.3% PEM, P < .001). DA use also increased the proportion of patients discussing ablation (66.7% DA versus 18.2% PEM, P = .02). Decision satisfaction measures were similar in both arms.
Patients receiving a small kidney mass DA are likely to gain knowledge and preparedness to discuss all treatment options over standard educational materials.
开发并初步测试一个用于描述小肾肿块以及治疗肿块的风险和益处的患者决策辅助工具（DA）。
一个专家委员会反复设计了一个小肾肿块 DA，将循证风险沟通和治疗方案的信息需求以及共同决策纳入其中。在对文献进行回顾以及在泌尿科医生、放射科医生和内科医生的反馈下起草内容之后，使用两个患者焦点小组进行快速定性评估，以告知以用户为中心的设计。在一项初步研究中，30 名患者在最初的泌尿科就诊时被随机分为接受 DA 或现有的机构患者教育材料（PEM）组。预咨询问卷记录了患者的知识和共同决策偏好。在查看 DA 并随后与临床医生进行咨询后，患者完成了关于讨论内容和满意度的问卷。使用 Fisher 精确检验比较组间比例，使用 Mann-Whitney 检验比较决策措施。
患者的信息需求包括主动监测和消融过程中肿瘤生长的风险、合并症的意义以及治疗后的恢复情况。对于 DA，84%的患者查看了所有内容，平均观看时间为 20 分钟。观察到对小肿块风险和治疗的知识有显著提高（平均总分：DA 组为 52.6%，PEM 组为 22.3%，P<0.001）。DA 的使用也增加了讨论消融的患者比例（DA 组为 66.7%，PEM 组为 18.2%，P=0.02）。两个组的决策满意度测量指标相似。
与标准教育材料相比，接受小肾肿块 DA 的患者可能会获得更多的知识并准备好讨论所有治疗方案。
