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Oswald D, Herrmann TRW, Netsch C, Becker B, Hatiboglu G, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Herrmann J, Gross AJ, Pallauf M, Deininger S, Ramesmayer C, Peters J, Lusuardi L. [Urinary diversion in old patients (80+ years)]. UROLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00120-024-02384-6. [PMID: 39012493 DOI: 10.1007/s00120-024-02384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/17/2024]
Abstract
With increasing life expectancy there is also an increased need for the management of older (≥ 80 years) patients with the diagnosis of muscle-invasive bladder cancer. Radical cystectomy with urinary diversion is the state of the art treatment (with neoadjuvant chemotherapy, as long as the patient is fit enough). Choosing the best urinary diversion with respect to morbidity compared to functionality and quality of life remains a challenge in these patients. Physical age alone is not decisive for making a decision. A thorough preoperative assessment of medical features, physical and cognitive impairments is more important. Older patients are generally provided with an ileal conduit as an incontinent urinary diversion, as the intervention involves reduced operating times and complexity compared to continent urinary diversions; however, in the case of good health status with an adequate life expectancy and sufficient compliance, continent diversions may be considered even in aged candidates. In the case of multimorbid patients with a high perioperative risk, ureterostomy with permanent ureteric stents is an important alternative. Most importantly, a thorough preoperative counselling enables patients to reach an informed decision.
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Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - T R W Herrmann
- Urologie, Abteilung für Urologie, Kantonsspital Frauenfeld, Frauenfeld, Schweiz
| | - C Netsch
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - B Becker
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Asklepios Klinik, Barmbek, Hamburg, Deutschland
| | | | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologie, Kantonsspital Münsterlingen, Münsterlingen, Schweiz
- Abteilung für Urologie, Uniklinikum Ulm, Abteilung für Urologie und Kinderurologie, Ulm, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - J Herrmann
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
- Klinik für Urologie und Urochirurgie, Universitätsklinkum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - A J Gross
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - M Pallauf
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - C Ramesmayer
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - J Peters
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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Trzciniecki M, Kowal P, Kołodziej J, Szydełko T, Kołodziej A. Choosing between Orthotopic Neobladder and Ileal Conduit after Radical Cystectomy: Tools for Assessing Patient-Specific Characteristics and Enhancing the Decision-Making Process-A Review of Current Studies. J Clin Med 2024; 13:3506. [PMID: 38930035 PMCID: PMC11205234 DOI: 10.3390/jcm13123506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Objective: The aim of the study was to find tools to assess patient characteristics that would help in choosing between orthotopic neobladder and ileal conduit in patients undergoing radical cystectomy. An additional goal was to search for aids that improve preoperative counseling to support patients in the decision-making process. Methods: A systematic review of MEDLINE, Web of Science, and Scopus databases was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, in April 2024. Inclusion criteria were specified in PICO format. Two reviewers independently screened titles/abstracts and full papers. Upon study selection, the results and conclusions from the studies were abstracted and quantitatively summarized in the results section of this article. Results: Seven articles, involving a total 834 patients, were included. One article described frailty, two reviewed cognitive status, one article described functional dexterity, one described personality, two articles reviewed patients' values and goals, and one article reviewed role of patient-physician dialogue in the context of choosing UD after RC. The reviewed articles identified tools and approaches that could be valuable in evaluating the suitability for continent urinary diversion (CUD) or incontinent urinary diversion (ICUD). Conclusions: This is the first systematic review that summarizes the new available methods of patient assessment which improve preoperative counseling and choosing the most suitable UD after RC. Efficient tools for this purpose are still missing, and further studies that will aid in creating a simple aid for patient selection are necessary.
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Affiliation(s)
- Maciej Trzciniecki
- Department of Urology, Regional Specialist Hospital, 51-124 Wroclaw, Poland
| | - Paweł Kowal
- Department of Urology, Regional Specialist Hospital, 51-124 Wroclaw, Poland
| | | | - Tomasz Szydełko
- Clinical Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Kołodziej
- Clinical Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-367 Wroclaw, Poland
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Büdenbender B, Köther AK, Kriegmair MC, Grüne B, Michel MS, Alpers GW. Getting specific: participation preference in urooncological decision-making. BMC Med Inform Decis Mak 2023; 23:114. [PMID: 37407999 DOI: 10.1186/s12911-023-02201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Shared decision-making is the gold standard for good clinical practice, and thus, psychometric instruments have been established to assess patients' generic preference for participation (e.g., the Autonomy Preference Index, API). However, patients' preferences may vary depending on the specific disease and with respect to the specific decision context. With a modified preference index (API-Uro), we assessed patients' specific participation preference in preference-sensitive decisions pertaining to urological cancer treatments and compared this with their generic participation preference. METHODS In Study 1, we recruited (N = 469) urological outpatients (43.1% urooncological) at a large university hospital. Participation preference was assessed with generic measures (API and API case vignettes) and with the disease-specific API-Uro (urooncological case vignettes describing medical decisions of variable difficulty). A polychoric exploratory factor analysis was used to establish factorial validity and reduce items. In Study 2, we collected data from N = 204 bladder cancer patients in a multicenter study to validate the factorial structure with confirmatory factor analysis. Differences between the participation preference for different decision contexts were analyzed. RESULTS Study 1: Scores on the specific urooncological case vignettes (API-Uro) correlated with the generic measure (r = .44) but also provided incremental information. Among the disease-specific vignettes of the API-Uro, there were two factors with good internal consistency (α ≥ .8): treatment versus diagnostic decisions. Patients desired more participation for treatment decisions (77.8%) than for diagnostic decisions (22%), χ2(1) = 245.1, p ≤ .001. Study 2: Replicated the correlation of the API-Uro with the API (r = .39) and its factorial structure (SRMR = .08; CFI = .974). Bladder cancer patients also desired more participation for treatment decisions (57.4%) than for diagnostic decisions (13.3%), χ²(1) =84, p ≤ .001. CONCLUSIONS The desire to participate varies between treatment versus diagnostic decisions among urological patients. This underscores the importance of assessing participation preference for specific contexts. Overall, the new API-Uro has good psychometric properties and is well suited to assess patients' preferences. In routine care, measures of participation preference for specific decision contexts may provide incremental, allowing clinicians to better address their patients' individual needs.
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Affiliation(s)
- Björn Büdenbender
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany
| | - Anja K Köther
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Britta Grüne
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany.
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Birkeland S, Bismark M, Barry MJ, Möller S. 'My doctor should decide' - Predictors for healthcare users' stated preferences regarding medical decision-making. PATIENT EDUCATION AND COUNSELING 2023; 114:107825. [PMID: 37269622 DOI: 10.1016/j.pec.2023.107825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate predictors for healthcare users' declared decision control preferences and test their association with satisfaction in vignettes detailing various decision-making. METHODS Cross-sectional vignette survey within a representative general male population aged 45-70 years (response rate 30%). Survey vignettes illustrated different levels of patient involvement. Participants rated their satisfaction with healthcare illustrated and separately rated their 'control preferences'. Comparisons were conducted with linear regression. RESULTS Preferring the doctor to predominantly or exclusively decide (1588/6755 respondents) was associated with older age, being single, lower education, having chronic illness, and living in low-income and less populated areas, with fewer non-western immigrants. Following adjustment, lower education and chronic illness remained statistically significant. Personalities with less openness had preference for least control. When presented with specific clinical scenarios, respondents preferring active or passive roles were equally satisfied with scenarios demonstrating shared decision-making. DISCUSSION Some groups of healthcare users were more likely to say that they preferred their doctor to decide. However, findings suggest that control preference statements, prior to facing a decision, should be interpreted with caution. PRACTICAL VALUE Study findings highlight that patients vary regarding their expressed wish for control in medical decision-making but they seem equally satisfied with shared decision-making scenarios.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000 Odense, Denmark.
| | - Marie Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000 Odense, Denmark
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Yi H, Xiao M, Wang J, Chen J. Development of a specific supportive care needs scale for radical cystectomy patients and its reliability and validity test. Urol Oncol 2022:S1078-1439(22)00435-5. [PMID: 36581514 DOI: 10.1016/j.urolonc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/01/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To develop a specific supportive care needs scale for patients who have undergone radical cystectomy, and to assess its reliability and validity. METHODS The clinical test version of the scale was developed based on literature review, qualitative interviews, Delphi method, and a pretest. The reliability and validity of the scale were assessed in a cohort of 603 patients who had undergone radical cystectomy at 5 Grade A hospitals in Chongqing, China. RESULTS The final scale included 26 items across the following 7 dimensions: health information needs, social needs, family support needs, physiological needs, sexual needs, daily activities needs, and psychological needs. The content validity index was 0.991 and the content validity indices of each item ranged from 0.889 to 1.00. Seven factors were extracted by exploratory factor analysis and the cumulative contribution of variance accounted for 70.762%. Confirmatory factor analysis revealed a good fit of the model (X2/df = 1.595, GFI = 0.904, IFI = 0.943, TLI = 0.932, CFI = 0.942, RMSEA = 0.044, and RMR = 0.026). The Cronbach's ɑ coefficient and retest reliability were 0.807 and 0.810, respectively. CONCLUSION The specific supportive care needs scale for radical cystectomy patients developed in this study showed the good reliability and validity. The tool can be invaluable for comprehensive assessment of the specific supportive care needs of these patients.
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Affiliation(s)
- Hongmei Yi
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Jun Wang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaojiao Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Köther AK, Büdenbender B, Grüne B, Holbach S, Huber J, von Landenberg N, Lenk J, Martini T, Michel MS, Kriegmair MC, Alpers GW. Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making. Cancer Med 2022; 11:2999-3008. [PMID: 35322925 PMCID: PMC9359866 DOI: 10.1002/cam4.4667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Patient-centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference-sensitive decisions. However, little is known about psychological patient characteristics that influence patient-reported preferences. We set out to explore the role of personality and anxiety for a preference-sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences. METHODS We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self-report questionnaires before this consultation, including measures of treatment preference, personality (BFI-10), anxiety (STAI), and participation preference (API and API-Uro), as well as sociodemographic characteristics. RESULTS Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro-oncological decisions (β = 0.207, p < 0.01). CONCLUSIONS Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.
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Affiliation(s)
- Anja K Köther
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Björn Büdenbender
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Britta Grüne
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sonja Holbach
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Marburg, Germany.,Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | - Julia Lenk
- Urological Hospital Munich-Planegg, Planegg, Germany
| | - Thomas Martini
- Department of Urology, University Hospital Ulm, Ulm, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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