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Shared decision making: why do patients choose ureteroscopy?

Mohamed Omar1, Sarah Tarplin1, Robert Brown1

  • 1Stevan Streem Center for Endourology and Stone Disease, Glickman Urology and Kidney Institute, The Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA.

Urolithiasis
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Summary
This summary is machine-generated.

Patient preferences for asymptomatic kidney stones vary, with success rates being the primary driver. Most patients trust physician recommendations, highlighting the need for shared decision-making in choosing treatments like shockwave lithotripsy (SWL) or ureteroscopy (URS).

Keywords:
CounselingPatients’ preferenceSWLURSUrolithiasis

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Area of Science:

  • Urology
  • Patient-centered care
  • Medical decision-making

Background:

  • Asymptomatic renal calculi management involves patient preferences and treatment characteristics.
  • Understanding factors influencing treatment selection is crucial for personalized urological care.

Purpose of the Study:

  • To identify patient characteristics influencing management decisions for asymptomatic renal calculi.
  • To assess the impact of anesthetic choices on selecting shockwave lithotripsy (SWL).

Main Methods:

  • A survey was administered to 100 patients in a multi-disciplinary stone clinic.
  • Patients evaluated hypothetical scenarios for an 8 mm lower pole stone, considering active surveillance, SWL, and ureteroscopy (URS).
  • Key decision-making variables included success rate, complication risk, and pain.

Main Results:

  • Shockwave lithotripsy (SWL) was preferred by 45% of patients, followed by URS (32%) and active surveillance (23%).
  • Treatment decisions were primarily driven by success rate (52%) and risk of complications (29%).
  • A significant majority (85%) relied on physician recommendations, emphasizing the importance of shared medical decisions.

Conclusions:

  • Patient choices for asymptomatic renal calculi are influenced by perceived success rates and risk tolerance.
  • Physician recommendations heavily impact treatment modality selection, necessitating a collaborative approach to care.
  • Tailoring treatment discussions to individual patient priorities regarding risk and success is essential for effective management.