Decisional Quality Among Patients Making Treatment Decisions for Urolithiasis

• Published in: Urology (Ridgewood, N.J.) N.J.), 2019-11, Vol.133, p.109-115
• Main Authors: Cabri, John N., Saigal, Christopher S., Lambrechts, Sylvia, Peña, Adam P., Weiser, Casey, Liu, Hui, Kwan, Lorna, Pollard, Matthew E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Decision Making; Female; Humans; Male; Middle Aged; Patient Participation; Patient Preference; Self Report; Urolithiasis - therapy; Young Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2019.07.023

To measure decisional quality, physician loyalty, and treatment preference in patients diagnosed with urolithiasis, a “preference-sensitive” condition, to identify areas of improvement to be addressed by a targeted shared decision-making intervention. We identified patients who presented for an initial consultation for urolithiasis from March 2016 to May 2017. Patients completed a 24-item patient experience questionnaire after the consultation which assessed decisional quality domains, physician loyalty, and treatment preference. We summarized treatment preferences before and after the consultation and described the changes. Among the total of 113 patients who met inclusion criteria, 78 (69%) patients chose to participate. Thirty-six (46%) of those patients had evidence of decisional conflict and 42 (54%) did not. Only 1 in 5 patients experiencing decisional conflict reported knowing the benefits and risks of each treatment option. Patients with decisional conflict reported lower perceived shared decision-making, treatment satisfaction, and urolithiasis knowledge. Physician loyalty was lower among patients with decisional conflict as well. Thirty-nine percent of them were ‘Promoters’ of their urologist, compared to 71% of patients without decisional conflict. Sixty-four percent of patients without decisional conflict identified a treatment preference before consultation, while only 17% of patients who experienced decisional conflict were able to do so. Many patients with urolithiasis experience decisional conflict and are unsure of their preferences when making a treatment choice. Uncertainty can correlate with low physician loyalty after consultation. This population may benefit from a shared decision-making intervention that improves decisional quality while incorporating patient-specific preferences.