Abstract: PD06-02
Sources of Funding: Supported in part by the H. H. Lee Research Program.

Introduction

Various practice guidelines advocate shared decision making (SDM) for preference-sensitive decisions. Decisional quality is a multidimensional construct that can be used to measure the impact of the decision making process. Decisional quality has been defined to include decisional conflict, disease specific knowledge, patient satisfaction, and sense that SDM has occurred in the visit. For patients that have urologic stone disease, little is known about decisional quality and shared decision making.

Methods

We identified new patients scheduled for evaluation of kidney stones within a large academic clinical setting. After the initial consultation, we conducted a patient feedback telephone survey. The survey instrument included the 4-item SURE instrument to evaluate decisional quality, 3 related items which measured specific concepts related to decisional conflict, 10 items measuring disease-specific knowledge, 1 item addressing patient satisfaction, the Net Promoter Score survey to measure patient loyalty, three items from the Shared Decision Making Questionnaire (SDM-Q), and a single question querying health literacy. We also evaluated their treatment preferences before and after the consultation.

Results

A total of 29 out of 30 patients we contacted participated in the survey. Fourteen patients had perfect SURE scores (SURE=4), indicating no decisional conflict, while 15 patients had scores indicating high decisional conflict after seeing the counseling urologist. Patients with perfect SURE scores reported improved perceived interactions with their urologist, feeling more included in the treatment decision (p = 0.0063), and were more likely to discuss treatment options (p = 0.0052). The total SDM scores indicated that patients without evidence of decisional conflict reported more perceived shared decision making (p = 0.0009). These patients also had higher Net Promoter Scores (higher intended physician loyalty) (p = 0.0086). There was no significant difference between the two groups in health literacy scores or disease specific knowledge scores.

Conclusions

This cross-sectional analysis of patients with nephrolithiasis suggests that lower decisional conflict after a urologic consultation for nephrolithiasis is associated with more shared decision-making and with higher levels of patient loyalty after consultation. Our data identifies specific areas that can be targeted with pre-consultation interventions aimed at building a solid foundation of shared decision making with the intent of improving decisional quality.

Funding

Supported in part by the H. H. Lee Research Program.