A Qualitative Analysis of Decisional Conflict in Kidney Stone Patients
Daniel Brownstein MS2, Sylvia Lambrechts MPH, MA, Matthew Dunn MD, Chris Saigal MD, MPH, Nishant Patel MD; Los Angeles, CA
UCLA Health System, Los Angeles, California
UCLA David Geffen School of Medicine, Los Angeles, California
Introduction and Objectives
Shared decision making (SDM) is a collaborative process between a fully informed patient and physician to arrive at a treatment decision that is in concordant with both the patient’s values and medical evidence. SDM has been shown in randomized controlled trials to improve patient involvement and knowledge, increase the likelihood of outcomes aligned with their personal preferences, and decrease inappropriate utilization of healthcare resources. Decision aids are electronic or printed educational interventions that have been shown to facilitate efficient SDM. However, decision aids should address patients’ key concerns in order to be effective. Qualitative research has been used in studies of other conditions to identify key patient concerns and other factors required for high quality decisions, but such research is lacking in the study of nephrolithiasis. Identifying these concerns may improve the quality of SDM and expand its benefits. Our objective is to identify elements considered important when making decisions by patients deciding on treatment for kidney stones.
Materials & Methods:
Patients were identified at a large academic medical center who were scheduled to see a urologist for an evaluation of new kidney stones, and had completed an existing decisional aid prior to their visit. Following their consult, patients who consented to the study participated in a 30-minute structured interview in person or over the telephone to better understand their decision process. The structured interview consisted of 11 items which examined the patient’s decision process and experiences with the decisional aid. Interviews were transcribed and parsed into individual quotes. We then identified overarching themes and assigned quotes to them utilizing the content analysis framework.
Six patients completed the decisional aid and our follow up structured interview after their initial new kidney stone consultation with a urologist. Three topic areas were evaluated using our structured interview process: Factors influencing treatment choice, Sources of Information in SDM, and Long-Term Goals of care. In terms of decision factors, the most important elements patients highlighted were the risk of complications (6 patients), having definitive treatment to become stone free (5 patients), likelihood of success (4 patients), deferring to physician recommendation for the treatment plan (4 patients) and recovery time (4 patients). Patients’ sources of information included their prior experience with stone disease (4 patients), physicians (4 patients) and family/friends (3 patients). 3 patients identified prevention of future stone recurrence as a key long-term goal.
Several important elements are critical to patient decision making during treatment counseling for kidney stone management including the risk of treatment complications and the ability of a treatment to definitively resolve their kidney stone problem. Patients tend to rely on prior experiences as well as information presented by their physician in SDM. This information can be used to improve our SDM program for patients with kidney stones.