This detailed study examined decision-making factors associated with decisional conflict among patients with clinical T1 renal masses. Drawing from a hybrid clinical trial, GRADE-SRM, the authors prospectively assessed decisional conflict – using the decisional conflict scale (DCS) – among 274 patients. Despite reporting overall low DCS scores, the authors note that half of patients with cT1 renal masses experience decisional conflict (i.e., DCS score > 25) at some point. Secondary analyses find that certain patient, tumor, and decision-making factors are associated with decisional conflict.
Previous studies demonstrate increased decisional conflict in patients with new cancer diagnoses1 with an associated decreased quality of life.2 This is increasingly salient in kidney cancer. Given kidney cancer’s stage migration towards early-stage disease, physicians may appropriately offer patients with small renal masses a range of management options, including active surveillance, ablative techniques, and surgery.3 The increasingly discretionary nature of kidney cancer management gives patients more treatment options, but also introduces decisional conflict.
As the authors demonstrate, factors beyond tumor characteristics may influence decisional conflict, implying the importance of well-implemented shared decision making and physician-patient communication. For example, the authors note that self-efficacy and information-seeking behavior are associated with lower decisional conflict. This underscores not only the importance of tailored communication in line with patient preferences, but also opportunities to improve patient satisfaction surrounding their healthcare decisions.
We note several limitations when interpreting the study’s results. In addition to recruiting patients from a single institution, the analysis may not adequately reflect heterogeneity in patient experiences (e.g., seeing a urologist prior to trial enrollment, underlying preference not captured in data collection). Despite these limitations, we commend the authors for their well-designed study. Their efforts to detail decisional conflict as a function of decision-making traits, cohort demographics, and tumor characteristics is informative and pushes cancer care forward.
References
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