Michael C Leo1, Scott M Gilbert2, Christopher S Wendel3, Robert S Krouse4, Marcia Grant5, Kim N Danforth6, Marilyn L Kwan7, Teresa N Harrison6, Joanna E Bulkley1, Carmit K McMullen1. 1. Kaiser Permanente Center for Health Research , Portland , Oregon. 2. Moffitt Cancer Center and Research Institute , Tampa , Florida. 3. University of Arizona School of Medicine , Tucson , Arizona. 4. Corporal Michael J. Crescenz Veterans Administration Medical Center and Department of Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania. 5. City of Hope/Beckman Research Institute , Duarte. 6. Department of Research and Evaluation, Kaiser Permanente , Pasadena. 7. Division of Research, Kaiser Permanente , Oakland , California.
Abstract
PURPOSE: Patient centered care aims to align treatment with patient goals, especially when treatment options have equivalent clinical outcomes. For surgeries with lasting impacts that alignment is critical. To our knowledge no psychometrically tested preference elicitation measures exist to support patients with bladder cancer treated with cystectomy, who can often choose between ileal conduit and neobladder diversions. In this study we created a scale to measure how patient goals align with each type of urinary diversion and the associated surgical outcomes. MATERIALS AND METHODS: We performed formative research through focus groups and clinician outreach to adapt a goal dissonance measure. We mailed a survey to adult Kaiser Permanente® members who underwent cystectomy for bladder cancer between January 2013 and June 2015. Eligible patients were identified through electronic health records and chart review. Surveys were mailed 5 to 7 months postoperatively. We administered our 10-item decision dissonance scale along with other decision making measures. We explored goal alignment as well as dissonance. Psychometric analysis included factor analysis, evaluation of scale scores between surgery groups and evaluation with other decision making scores. RESULTS: We identified 10 goals associated with ileal conduit or neobladder diversion. Using survey data on 215 patients our scale differentiated patient goals associated with each diversion choice. On average patients with a neobladder strongly valued neobladder aligned goals such as maintaining body integrity and volitional voiding through the urethra. Patients with an ileal conduit had neutral values on average across all goals. CONCLUSIONS: Our measure lays the foundation for a simple value elicitation approach which could facilitate shared decision making about urinary diversion choice.
PURPOSE:Patient centered care aims to align treatment with patient goals, especially when treatment options have equivalent clinical outcomes. For surgeries with lasting impacts that alignment is critical. To our knowledge no psychometrically tested preference elicitation measures exist to support patients with bladder cancer treated with cystectomy, who can often choose between ileal conduit and neobladder diversions. In this study we created a scale to measure how patient goals align with each type of urinary diversion and the associated surgical outcomes. MATERIALS AND METHODS: We performed formative research through focus groups and clinician outreach to adapt a goal dissonance measure. We mailed a survey to adult Kaiser Permanente® members who underwent cystectomy for bladder cancer between January 2013 and June 2015. Eligible patients were identified through electronic health records and chart review. Surveys were mailed 5 to 7 months postoperatively. We administered our 10-item decision dissonance scale along with other decision making measures. We explored goal alignment as well as dissonance. Psychometric analysis included factor analysis, evaluation of scale scores between surgery groups and evaluation with other decision making scores. RESULTS: We identified 10 goals associated with ileal conduit or neobladder diversion. Using survey data on 215 patients our scale differentiated patient goals associated with each diversion choice. On average patients with a neobladder strongly valued neobladder aligned goals such as maintaining body integrity and volitional voiding through the urethra. Patients with an ileal conduit had neutral values on average across all goals. CONCLUSIONS: Our measure lays the foundation for a simple value elicitation approach which could facilitate shared decision making about urinary diversion choice.
Authors: Joanna E Bulkley; Maureen O'Keeffe-Rosetti; Christopher S Wendel; James V Davis; Kim N Danforth; Teresa N Harrison; Marilyn L Kwan; Julie Munneke; Neon Brooks; Marcia Grant; Michael C Leo; Matthew Banegas; Sheila Weinmann; Carmit K McMullen Journal: Qual Life Res Date: 2019-12-06 Impact factor: 4.147
Authors: Kevin Mertz; Romil F Shah; Sara L Eppler; Jeffrey Yao; Marc Safran; Ariel Palanca; Serena S Hu; Michael Gardner; Derek F Amanatullah; Robin N Kamal Journal: Med Decis Making Date: 2020-08-01 Impact factor: 2.583