European urology oncology · 2026
Improved Shared Decision-making for Patients with Renal Cell Carcinoma: Results of the SDM-RCC Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Bresser Cato C, Garvelink Mirjam M, van Dijk Tessa, van der Linde Nienke, van den Berg Birgitta M M, Dolk Franklin C K, van Melick Harm H E, van der Nat Paul B, SDM-RCC Study Group
Аннотация
BACKGROUND AND OBJECTIVE: To improve shared decision-making (SDM) for renal cell carcinoma (RCC), we implemented an SDM intervention consisting of a patient decision aid and health care professional (HCP) training. This study evaluates its effectiveness.
DESIGN, SETTING, AND PARCTICIPANTS: Multicenter prospective pretest-post-test study including adults with localized RCC or metastatic clear cell RCC. The pretest group received standard care; the post-test group was included after SDM intervention implementation.
OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS: The primary outcome was the Observing Patient Involvement in Decision-making (OPTION)-5 score, measuring patient involvement. Secondary outcomes included HCP- and patient-reported SDM and decision quality (eg, Decisional Conflict Scale [DCS], Control Preference Scale [CPS]). Exploratory outcomes were quality of life, quality of the decision-making process (ie, Assessing Communication about Evidence and Patient Preferences [ACEPP] subscale 1A), and process indicators (eg, treatment decision). Mixed-effects regression model with random intercepts for hospital was used.
RESULTS AND LIMITATIONS: Post-test, OPTION-5 scores increased significantly (47.2-60.5; mean difference 13.2; 95% CI [8.7-17.8]; p < 0.001), with improvements across most hospitals and all OPTION-5 items. HCP-reported SDM and ACEPP subscale 1A also increased (both p < 0.001), while patient-reported SDM remained unchanged. The number and duration of consultations increased, and DCS uncertainty scores showed more conflict, while the CPS remained unchanged. The pretest-post-test design minimized inter-hospital workflow variation and supported sustained behavioral change but limits causal inference.
CONCLUSIONS: Implementation of an SDM intervention was significantly associated with observed and HCP-reported SDM, while patient-perceived involvement remained similar. These findings suggest integrating the SDM intervention into routine RCC care to promote patient-centered decision-making.
DESIGN, SETTING, AND PARCTICIPANTS: Multicenter prospective pretest-post-test study including adults with localized RCC or metastatic clear cell RCC. The pretest group received standard care; the post-test group was included after SDM intervention implementation.
OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS: The primary outcome was the Observing Patient Involvement in Decision-making (OPTION)-5 score, measuring patient involvement. Secondary outcomes included HCP- and patient-reported SDM and decision quality (eg, Decisional Conflict Scale [DCS], Control Preference Scale [CPS]). Exploratory outcomes were quality of life, quality of the decision-making process (ie, Assessing Communication about Evidence and Patient Preferences [ACEPP] subscale 1A), and process indicators (eg, treatment decision). Mixed-effects regression model with random intercepts for hospital was used.
RESULTS AND LIMITATIONS: Post-test, OPTION-5 scores increased significantly (47.2-60.5; mean difference 13.2; 95% CI [8.7-17.8]; p < 0.001), with improvements across most hospitals and all OPTION-5 items. HCP-reported SDM and ACEPP subscale 1A also increased (both p < 0.001), while patient-reported SDM remained unchanged. The number and duration of consultations increased, and DCS uncertainty scores showed more conflict, while the CPS remained unchanged. The pretest-post-test design minimized inter-hospital workflow variation and supported sustained behavioral change but limits causal inference.
CONCLUSIONS: Implementation of an SDM intervention was significantly associated with observed and HCP-reported SDM, while patient-perceived involvement remained similar. These findings suggest integrating the SDM intervention into routine RCC care to promote patient-centered decision-making.