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Ossin DA, Carter EC, Cartwright R, Violette PD, Iyer S, Klein GT, Senapati S, Klaassen Z, Botros SM. Shared decision-making in urology and female pelvic floor medicine and reconstructive surgery. Nat Rev Urol 2022; 19:161-170. [PMID: 34931058 DOI: 10.1038/s41585-021-00551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
Shared decision-making (SDM) is a hallmark of patient-centred care that uses informed consent to help guide patients with making complex health-care decisions. In SDM, patients and providers work together to determine the best course of action based on both the current available evidence and the patient's values and preferences. SDM not only provides a framework for the legal and ethical obligations providers need to fulfil for informed consent, but also leads to improved knowledge of treatment options and satisfaction of decision-making for patients. Tools such as decision aids have been developed to support SDM for complex decisions. Several decision aids are available for use in the field of urology and female pelvic medicine and reconstructive surgery, but these decision aids are also associated with barriers to SDM implementation including patient, provider and systematic challenges. However, solutions to such barriers to SDM include continued development of SDM tools to improve patient engagement, expand training of providers in SDM communication models and a process to encourage implementation of SDM.
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Affiliation(s)
- David A Ossin
- Division of Urogynecology, Department of Urology, University of Texas Health San Antonio, Joe R & Theresa Long School of Medicine, San Antonio, TX, USA.
| | - Emily C Carter
- Department of Obstetrics and Gynaecology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Rufus Cartwright
- Department of Urogynaecology, LNWH NHS Trust, London, UK & Department of Epidemiology & Biostatistics, Imperial College London, London, UK
| | - Philippe D Violette
- Department of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shilpa Iyer
- Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, The University of Chicago, Chicago, IL, USA
| | - Geraldine T Klein
- Department of Urology Eisenhower Medical Associates, Rancho Mirage, CA, USA
| | - Sangeeta Senapati
- Department of Obstetrics and Gynecology, Northshore University HealthSystem, Evanston, IL, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Sylvia M Botros
- Division of Urogynecology, Department of Urology, University of Texas Health San Antonio, Joe R & Theresa Long School of Medicine, San Antonio, TX, USA
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Villa G, Galli E, Azzimonti V, Doneda M, Giannetta N, Manara DF. Empowerment-Based Education in Urological Patients: A Scoping Review. Clin Nurs Res 2021; 31:666-689. [PMID: 34323106 DOI: 10.1177/10547738211030389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prostate, kidney, and bladder cancer are the three most frequently diagnosed urological cancers. Educational programs could teach patients to become experts in disease management. The aim of this scoping review was to explore the literature to identify the educational requirements and strategies for improving and implementing educational processes for urological patients undergoing surgery. We searched several databases, including PubMed, CINAHL, Embase, Scopus, PsycINFO, and Cochrane Library. All adult patients undergoing urological educational interventions were included in the review. Of 3,197 initially identified articles, 42 were retained. Urological patients undergoing prostatectomy, cystectomy, and nephrectomy require cognitive, psychological, and functional support. For each level of support, several methods exist to provide support, including informational brochures, preoperative counseling, telephone support, online content, educational videos, support groups, individual stress management interventions, peer support, online interventions, partner support, and various educational programs that help the patient manage negative effects associated with the urological intervention.
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Affiliation(s)
- Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University of Milan, Lombardia, Italy
| | - Emanuele Galli
- Nursing School San Raffaele Hospital, Vita-Salute San Raffaele University of Milan, Lombardia, Italy.,IRCSS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | | | - Marianna Doneda
- IRCSS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Noemi Giannetta
- Vita-Salute San Raffaele University of Milan, Lombardia, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University of Milan, Lombardia, Italy
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McAlpine K, Breau RH, Stacey D, Knee C, Jewett MAS, Violette PD, Richard PO, Cagiannos I, Morash C, Lavallée LT. Shared decision-making for the management of small renal masses: Development and acceptability testing of a novel patient decision aid. Can Urol Assoc J 2020; 14:385-391. [PMID: 32574143 DOI: 10.5489/cuaj.6575] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Shared decision-making incorporates patients' values and preferences to achieve high-quality decisions. The objective of this study was to develop an acceptable patient decision aid to facilitate shared decision-making for the management of small renal masses (SRMs). METHODS The International Patient Decision Aids Standards were used to guide an evidence-based development process. Management options included active surveillance, thermal ablation, partial nephrectomy, and radical nephrectomy. A literature review was performed to provide incidence rates for outcomes of each option. Once a prototype was complete, alpha-testing was performed using a 10-question survey to assess acceptability with patients, patient advocates, urologists, and methodological experts. The primary outcome was acceptability of the decision aid. RESULTS A novel patient decision aid was created to facilitate shared decision-making for the management of SRMs. Acceptability testing was performed with 20 patients, 10 urologists, two patient advocates, and one methodological expert. Responders indicated the decision aid was appropriate in length (82%, 27/33), well-balanced (82%, 27/33), and had language that was easy to follow (94%, 31/33). All patient responders felt the decision aid would have been helpful during their consultation and would recommend the decision aid for future patients (100%, 20/20). Most urologists reported they intend to use the decision aid (90%, 9/10). CONCLUSIONS A novel patient decision aid was created to facilitate shared decision-making for management of SRMs. This clinical tool was acceptable with patients, patient advocates, and urologists and is freely available at: https://decisionaid.ohri.ca/decaids.html.
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Affiliation(s)
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Knee
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Philippe D Violette
- Departments of Health Research Methods Evidence and Impact and Surgery, McMaster University, Hamilton, ON, Canada
| | - Patrick O Richard
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Ilias Cagiannos
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Rai Y, Zheng S, Chappell H, Pulandiran M, Jones J. Kidney cancer survivorship care: Patient experiences in a Canadian setting. Can Urol Assoc J 2019; 14:E560-E567. [PMID: 32520710 DOI: 10.5489/cuaj.6217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The incidence of kidney cancer (KCa) in Canada is rising. Despite this, there is a shortage of research assessing KCa care experiences. This study aims to explore the current experiences of KCa survivors related to treatment and management, information provision, and barriers to care. METHODS A cross-sectional, descriptive study of KCa patients was conducted online and through various cancer centers across Canada. English- and French-speaking adults who received a KCa diagnosis and were currently undergoing treatment or had completed treatment in Canada were eligible to participate. RESULTS In total, 368 surveys were completed. Ten percent of respondents had not yet received treatment, 29% were receiving treatment, and 56% had completed treatment. Most respondents (72%) had localized KCa (stage 0-3) at diagnosis. Sixty-one percent of respondents reported that their doctors discussed various treatment options with them and 24% reported discussing applicable clinical trials. Most (85%) respondents received information about their KCa and 36% discussed where to get information about their disease and support. The most commonly reported barriers to care were side effects (26%), system delays (26%), not having access to certain treatments (25%), and financial burden (24%). More participants in Central Region and Quebec (p=0.004) and rural/suburban (p=0.014) areas reported lacking access to certain treatments and KCa experts. CONCLUSIONS This was the first large-scale study to explore access to care experiences of Canadian KCa survivors. Results show examples of good patient-centered care and provide new practical information that can inform efforts to improve patient-centered care for KCa patients.
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Affiliation(s)
- Yeshith Rai
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Shiyu Zheng
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | | | - Menaka Pulandiran
- Clinical Research Support Systems, University Health Network, Toronto, ON, Canada
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
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Corradi R, Kabra A, Suarez M, Oppenheimer J, Okhunov Z, White H, Nougaret S, Vargas HA, Landman J, Coleman J, Liss MA. Validation of 3D volumetric-based renal function prediction calculator for nephron sparing surgery. Int Urol Nephrol 2017; 49:615-621. [PMID: 28161843 DOI: 10.1007/s11255-017-1525-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/23/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate a recently published volume-based renal function prediction calculator intended to be used in small renal mass surgical counseling. METHODS Retrospective data collection included three-dimensional calculation of renal mass and parenchyma of patients who have undergone extirpative therapy. The predicted glomerular filtration rate (GFR) was calculated using the online calculator. The predicted GFR was compared with the actual 6-month GFR. The Pearson correlation coefficient, paired t test and root-mean-square error (RMSE) are utilized for statistical analysis. RESULTS After institutional review board approval, three institutions provided data for analysis. After patients with renal mass size >300 cc, renal size >400 cc or preoperative CKD ≥stage 3 had been excluded, we retrospectively analyzed data from 136 patients. The median mass volume was 22.2 cc (IQR 7-49). In multiple linear regression analysis, the most significant variables predicting postoperative GFR were partial versus radical nephrectomy and preoperative GFR with an overall R2 of .68 (F = 26.13, P < .001). The predicted GFR was 75.4 mL/min/1.73 m2 compared to an actual GFR of 70.7 mL/min/1.73 m2 (P < .001, paired t test). The predicted GFR was highly correlated with the actual postoperative GFR at 6 months (Pearson correlation, r = .65, P < .001). RMSE of the validation cohort was 16.87. CONCLUSIONS The predictive tool to determine renal function benefit of nephron sparing surgery compared to radical nephrectomy online calculator effectively predicts GFR and could potentially be used to help urologists and patients discuss renal function prior to extirpative renal surgery.
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Affiliation(s)
- Renato Corradi
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aashish Kabra
- Department of Urology, University of Texas Health Science Center San Antonio, 7703, Floyd Curl Drive, San Antonio, TX, USA
| | - Melissa Suarez
- Department of Urology, University of California-Irvine, Irvine, CA, USA
| | - Jacob Oppenheimer
- Department of Urology, University of Texas Health Science Center San Antonio, 7703, Floyd Curl Drive, San Antonio, TX, USA
| | - Zhamshid Okhunov
- Department of Urology, University of California-Irvine, Irvine, CA, USA
| | - Hugh White
- Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- INSERM, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France
- Service de Radiologie, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Hebert A Vargas
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaime Landman
- Department of Urology, University of California-Irvine, Irvine, CA, USA
| | - Jonathan Coleman
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Liss
- Department of Urology, University of Texas Health Science Center San Antonio, 7703, Floyd Curl Drive, San Antonio, TX, USA.
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Liss MA, DeConde R, Caovan D, Hofler J, Gabe M, Palazzi KL, Patel ND, Lee HJ, Ideker T, Van Poppel H, Karow D, Aertsen M, Casola G, Derweesh IH. Parenchymal Volumetric Assessment as a Predictive Tool to Determine Renal Function Benefit of Nephron-Sparing Surgery Compared with Radical Nephrectomy. J Endourol 2015; 30:114-21. [PMID: 26192380 DOI: 10.1089/end.2015.0411] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To develop a preoperative prediction model using a computer-assisted volumetric assessment of potential spared parenchyma to estimate the probability of chronic kidney disease (CKD, estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m(2)) 6 months from extirpative renal surgery (nephron-sparing surgery [NSS] or radical nephrectomy [RN]). PATIENTS AND METHODS Retrospective analysis of patients who underwent NSS or RN at our institution from January 2000 to June 2013 with a compatible CT scan 6-month renal function follow-up was performed. Primary outcome was defined as the accuracy of 6-month postoperative eGFR compared with actual postoperative eGFR based on root mean square error (RMSE). Models were constructed using renal volumes and externally validated. A clinical tool was developed on the best model after a given surgical procedure using area under the curve (AUC). RESULTS We identified 130 (51 radical, 79 partial) patients with a median age of 58 years (interquartile range [IQR] 48-67) and preoperative eGFR of 82.1 (IQR 65.9-104.3); postoperative CKD (eGFR <60) developed in 42% (55/130). We performed various linear regression models to predict postoperative eGFR. The Quadratic model was the highest performing model, which relied only on preoperative GFR and the volumetric data for a RMSE of 15.3 on external validation corresponding to a clinical tool with an AUC of 0.89. CONCLUSION Volumetric-based assessment provides information to predict postoperative eGFR. A tool based on this equation may assist surgical counseling regarding renal functional outcomes before renal tumor surgical procedures.
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Affiliation(s)
- Michael A Liss
- 1 Department of Urology, UC San Diego Health , La Jolla, California
| | - Robert DeConde
- 2 Department of Bioengineering, UC San Diego Health , La Jolla, California
| | - Dominique Caovan
- 3 Department of Radiology, UC San Diego Health , La Jolla, California
| | - Joseph Hofler
- 4 Department of Mathematics, Technical University Munich , Garching, Germany
| | - Michael Gabe
- 3 Department of Radiology, UC San Diego Health , La Jolla, California
| | - Kerrin L Palazzi
- 1 Department of Urology, UC San Diego Health , La Jolla, California
| | - Nishant D Patel
- 1 Department of Urology, UC San Diego Health , La Jolla, California
| | - Hak J Lee
- 1 Department of Urology, UC San Diego Health , La Jolla, California
| | - Trey Ideker
- 2 Department of Bioengineering, UC San Diego Health , La Jolla, California
| | | | - David Karow
- 3 Department of Radiology, UC San Diego Health , La Jolla, California
| | - Michael Aertsen
- 6 Department of Radiology, University Hospitals Leuven , Leuven, Belgium
| | - Giovanna Casola
- 3 Department of Radiology, UC San Diego Health , La Jolla, California
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