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Published on: March 30, 2015
Exploring Management Preferences Among Patients with Small Renal Masses: Results from a Pilot Study
Clara Diaz1, Maryam Kandi2, Philippe D Violette3
1Research Program in Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada; Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
Background And Objective:
Most patients diagnosed with a small renal mass (SRM) undergo definitive treatment, but active surveillance may be offered as an alternative. Our aim was to determine patient preferences regarding management of their SRM.
Methods:
In this multicenter prospective pilot study, we conducted structured online interviews with patients with a new SRM diagnosis. During the interviews, patients reviewed outcome data and stated their preference for definitive treatment (thermal ablation vs partial nephrectomy). Then the patients reviewed hypothetical scenarios in a ping-pong approach and chose the maximum change in the probability of death from kidney cancer they would be willing to accept in order to decline definitive treatment.
Key Findings And Limitations:
Of the 41 participants interviewed, 71% (n = 29) preferred thermal ablation over surgery. While the median maximum increase in the probability of death from kidney cancer that patients were willing to accept to decline definitive treatment was 0.1% (interquartile range 0.1-2.5%) at 5 yr, 27% of patients reported a threshold ≥2%. Most patients (97%) preferred to review data in the form of a "reduction in the risk of death", rather than an "increase in the risk of death", or expressed no preference. Limitations include the small sample size.
Conclusions And Clinical Implications:
This pilot study demonstrates the feasibility of an innovative approach for evaluating the preferences of patients with SRMs and establishes a robust methodology for future studies. Results highlighted a strong preference for thermal ablation and for presenting data in terms of the reduction in mortality risk. Larger studies are required to validate our findings.
Insights
Most patients with small renal masses (SRMs) prefer less invasive thermal ablation over surgery. Patients also favor understanding treatment risks as a reduction in mortality, not an increase.
Area of Science:
- Urology
- Oncology
- Medical Decision Making
Background:
- Small renal masses (SRMs) are often treated definitively, but active surveillance is an alternative.
- Patient preferences for SRM management are not fully understood.
- Understanding patient preferences is crucial for shared decision-making in SRM treatment.
Purpose of the Study:
- To determine patient preferences for managing small renal masses (SRMs).
- To compare patient preferences between definitive treatments like thermal ablation and partial nephrectomy.
- To assess patient willingness to accept increased mortality risk for avoiding definitive treatment.
Main Methods:
- A multicenter prospective pilot study involving structured online interviews with 41 new SRM patients.
- Patients reviewed outcome data and expressed preferences for thermal ablation versus partial nephrectomy.
- Hypothetical scenarios were used to determine the acceptable increase in mortality risk to decline treatment.
Main Results:
- 71% of patients preferred thermal ablation over partial nephrectomy.
- The median acceptable increase in 5-year cancer death probability to decline treatment was 0.1%.
- 97% of patients preferred risk data presented as a reduction in mortality risk.
Conclusions:
- This pilot study confirms the feasibility of assessing patient preferences for SRM management.
- A strong patient preference exists for thermal ablation and for presenting risk data in terms of mortality reduction.
- Larger studies are needed to validate these findings and inform clinical practice.
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