Kristen McAlpine1, Luke T Lavallée1,2, Dawn Stacey3, Preveshen Moodley4, Ilias Cagiannos1,2, Christopher Morash1,2, Peter C Black5, Girish S Kulkarni6, Bobby Shayegan7, Wassim Kassouf8, Robert Siemens9, Alan So5, Michael J Leveridge9, Stephen A Boorjian10, Siamak Daneshmand11, Angela B Smith12, Nicholas Power13, Jonathan Izawa13, Darrel E Drachenberg14, Adrian Fairey15, Ricardo A Rendon16, Rodney H Breau1,2. 1. Division of Urology, University of Ottawa, Ottawa, Canada. 2. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. 3. School of Nursing, University of Ottawa, Ottawa, Canada. 4. Divisions of Urology, Health Sciences North, Sudbury, Ontario, Canada. 5. Department of Urologic Sciences, University of British Columbia, Vancouver, Canada. 6. University Health Network, Toronto, Ontario, Canada. 7. Departments of Surgery, McMaster University, Hamilton, Canada. 8. McGill University, Montreal, Quebec, Canada. 9. Queen's University, Kingston, Canada. 10. Departments of Urology, Mayo Clinic, Rochester, Minnesota. 11. Institute of Urology, University of Southern California, Los Angeles, California. 12. University of North Carolina, Chapel Hill, North Carolina. 13. Western University, London, Ontario, Canada. 14. British Columbia and Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. 15. University of Alberta, Edmonton, Alberta, Canada. 16. Dalhousie University, Halifax, Nova Scotia, Canada.
Abstract
PURPOSE: The choice of urinary diversion at cystectomy is a life altering decision. Patient decision aids are clinical tools that promote shared decision making by providing information about management options and helping patients communicate their values. We sought to develop and evaluate a patient decision aid for individuals undergoing cystectomy with urinary diversion. MATERIALS AND METHODS: We used the IPDAS (International Patient Decision Aids Standards) to guide a systematic development process. A literature review was performed to determine urinary diversion options and the incidence of outcomes. We created a prototype using the Ottawa Decision Support Framework. A 10-question survey was used to assess patient decision aid acceptability among patients, allied health professionals and urologists. The primary outcome was acceptability of the patient decision aid. RESULTS: Ileal conduit and orthotopic neobladder were included as primary urinary diversion options because they had the most evidence and are most commonly performed. Continent cutaneous diversion was identified as an alternative option. Outcomes specific to ileal conduit were stomal stenosis and parastomal hernia. Outcomes specific to neobladder were daytime and nighttime urinary incontinence and urinary retention. Acceptability testing was completed by 8 urologists, 9 patients and 1 advanced practice nurse. Of the respondents 94% reported that the language was appropriate, 94% reported that the length was adequate and 83% reported that option presentation was balanced. The patient decision aid met all 6 IPDAS defining criteria, all 6 certification criteria and 21 of 23 quality criteria. CONCLUSIONS: We created a novel patient decision aid to improve the quality of decisions made by patients when deciding among urinary diversion options. Effectiveness testing will be performed prospectively.
PURPOSE: The choice of urinary diversion at cystectomy is a life altering decision. Patient decision aids are clinical tools that promote shared decision making by providing information about management options and helping patients communicate their values. We sought to develop and evaluate a patient decision aid for individuals undergoing cystectomy with urinary diversion. MATERIALS AND METHODS: We used the IPDAS (International Patient Decision Aids Standards) to guide a systematic development process. A literature review was performed to determine urinary diversion options and the incidence of outcomes. We created a prototype using the Ottawa Decision Support Framework. A 10-question survey was used to assess patient decision aid acceptability among patients, allied health professionals and urologists. The primary outcome was acceptability of the patient decision aid. RESULTS: Ileal conduit and orthotopic neobladder were included as primary urinary diversion options because they had the most evidence and are most commonly performed. Continent cutaneous diversion was identified as an alternative option. Outcomes specific to ileal conduit were stomal stenosis and parastomal hernia. Outcomes specific to neobladder were daytime and nighttime urinary incontinence and urinary retention. Acceptability testing was completed by 8 urologists, 9 patients and 1 advanced practice nurse. Of the respondents 94% reported that the language was appropriate, 94% reported that the length was adequate and 83% reported that option presentation was balanced. The patient decision aid met all 6 IPDAS defining criteria, all 6 certification criteria and 21 of 23 quality criteria. CONCLUSIONS: We created a novel patient decision aid to improve the quality of decisions made by patients when deciding among urinary diversion options. Effectiveness testing will be performed prospectively.
Entities:
Keywords:
cystectomy,; decision support techniques,; surveys and questionnaires; urinary bladder neoplasms,; urinary diversion,
Authors: David Bouhadana; David-Dan Nguyen; Brendan Raizenne; Joe Schwarcz; Harvey Gordon; Bilal Chughtai; Dean S Elterman; Luke T Lavallée; Paul Martin; Kristen McAlpine; Ryan Paterson; Hassan Razvi; Kevin C Zorn; Naeem Bhojani Journal: Can Urol Assoc J Date: 2021-08 Impact factor: 1.862
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