JU INSIGHT Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: Prospective Study

By: Amir Feinberg, MD, University of North Carolina at Chapel Hill; Kathryn H. Gessner, MD, PhD, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Allison M. Deal, MS, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Hillary M. Heiling, PhD, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Shannon Myers, BS, University of North Carolina at Chapel Hill; Mathew C. Raynor, MD, University of North Carolina at Chapel Hill; Matthew I. Milowsky, MD, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Sara E. Wobker, MD, University of North Carolina at Chapel Hill; Clayton W. Commander, MD, PhD, University of North Carolina at Chapel Hill; Allison J. Lazard, PhD, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Hussman School of Journalism and Media, University of North Carolina at Chapel Hill; Marc A. Bjurlin, DO, MS, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Angela B. Smith, MD, MS, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; David C. Johnson, MD, MPH, University of North Carolina at Chapel Hill; Eric M. Wallen, MD, University of North Carolina at Chapel Hill; William Y. Kim, MD, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Hung-Jui Tan, MD, MSHPM, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill | Posted on: 12 Aug 2024

Feinberg A, Gessner KH, Deal AM, et al. Decisional conflict among patients newly diagnosed with clinical T1 renal masses: a prospective study. J Urol. 2024; 212(2):320-330. doi:10.1097/JU.0000000000004023

Study Need and Importance

Given the natural history of many clinical T1 renal masses and the multitude of management options now available, decision-making has become increasingly complex for both patients and their urologists. However, data on the decision-making experience from the patient’s perspective remain limited. Accordingly, this study sought to characterize the burden of decisional conflict (ie, uncertainty about the course of action to pursue) among patients newly diagnosed with clinical T1 renal masses along with contributing factors. In better understanding decisional conflict, we can develop strategies to support patients presenting with this disease.

What We Found

In this prospective clinical trial, decisional conflict levels varied with 50% of participants reporting elevated decisional conflict (score ≥25) at some point during their decision-making process (Figure). Older age, greater tumor complexity, and cystic mass type emerged as patient and clinical factors associated with increased decisional conflict. Decision-making factors including greater self-efficacy and information-seeking behavior yielded lower decisional conflict. Patients who reported better, more patient-centered communication with their urologist also had less decisional conflict.

Figure. Maximum Decisional Conflict Scale (DCS) scores. Violin plot depicts distribution of the maximum DCS score per participant during either time point 1 or 2 for total DCS and each subdomain. Scores ≥ 25, as indicated by the dotted red line, signify higher decisional conflict. Individual density curves are built around first quartile, median, and third quartile.

Limitations

This study was conducted at a single institution, which may limit generalizability. Some patients saw a referring urologist prior to study participation, which may alter their perspective. The assessment of decision-making factors, though extensive, did not include shared decision-making or trust that could impact decisional conflict. Other aspects of care like renal mass biopsy and treatment choice remained outside the scope of this analysis.

Interpretation for Patient Care

Many patients experience difficulty when making a decision about their clinical T1 renal mass. While this appears to be due in part to clinical complexity, difficulties also relate to how patients process information and make decisions. Considering these decision-making factors when counseling patients may be a key lever to reduce decisional conflict and improve the overall experience for patients presenting with clinical T1 renal masses.