The role of a novel decision aid to support informed decision making process in patients with a symptomatic non - lower pole renal stone < 20 mm in diameter: a prospective randomized study

ABSTRACT Objectives To evaluate the efficacy of a novel decision aid (DA) in improving the patients’ level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone <2 cm. Materials and Methods In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge. Results Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge. Conclusions In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone <20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.

摘要
研究目的：评估新型决策辅助工具（decision aid, DA）在症状性直径小于2厘米肾结石患者选择体外冲击波碎石术（Shock Wave Lithotripsy, SWL）与输尿管软镜碎石术（Retrograde Intrarenal Surgery, RIRS）时，对提升患者知识水平及降低决策冲突的有效性。
材料与方法：本研究为前瞻性随机对照研究，将患者随机分为两组，第1组（n=57）接受标准告知流程，第2组（n=58）接受决策辅助工具干预。采用10条目调查问卷分别在告知流程前后评估患者知识水平；采用先前已验证的评分系统评估患者决策冲突程度。通过logistic回归分析识别与知识水平达标相关的影响因素。
结果：两组患者在接受告知流程后，知识水平均显著提升，且第2组的提升幅度更为显著（p=0.045）。第2组知识水平达标患者占比亦更高（56.1% vs. 74.1%，p=0.04）。第1组的决策冲突量表平均得分（得分越高提示决策冲突程度越严重）显著高于第2组（14.7±14.5 vs. 10.1±13.7，p=0.045）。多因素logistic回归分析显示，较高学历（大学及以上）与使用决策辅助工具是知识水平达标的相关因素。
结论：本研究结果表明，针对直径小于20毫米的非下盏症状性肾结石患者，决策辅助工具可有效提升其知识水平并降低决策冲突程度。我们建议在肾结石诊疗门诊中，针对特定临床场景开发并应用决策辅助工具，以辅助患者教育与共同决策流程的开展。