Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making

Reconstructive Urology Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making Lindsay A. Hampson, Isabel E. Allen, Thomas W. Gaither, Tracy Lin, Jie Ting, E. Charles Osterberg, Leslie Wilson, and Benjamin N. Breyer OBJECTIVE METHODS RESULTS CONCLUSION To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased pa- tients’ decisional conflict about treatment preferences for surgical management of urethral stric- ture disease. Understanding patient preferences for treatment decisions assists in shared decision- making and emphasizes patient-centered outcomes. CA offers a method to understand what risks patients are willing to take for what gains. The CA methodology was used by providing participants with case-based choices to elucidate the relative importance that individuals place on various treatment aspects. Patients’ decisional conflict regarding surgery for urethral stricture was assessed before and after the CA exercise to assess the impact the exercise had on their decisional conflict. Completion of the CA exercise resulted in a significant decrease in decisional conflict (P < .001). The majority (59.5%) of participants with decisional conflict before the CA exercise experi- enced a decrease in decisional conflict afterwards, with only a minority (16.5%) experiencing new decisional conflict after the exercise. Participants felt the choice-based CA exercise was helpful in deciding what was important in making treatment decisions (70%) and in expressing their priorities and treatment preferences (82%). The number needed to counsel to achieve a decrease in decisional conflict was 1.69 and to achieve no decisional conflict was 3.65. Choice-based CA improves patients’ ability to express their treatment preferences and decreases decisional conflict. CA may be a new tool that physicians and patients can use to aid in shared decision-making with a focus on patient-centered outcomes. UROLOGY 99: 246–253, 2017. © 2016 Elsevier Inc. H ealthcare decisions inevitably involve trade-offs of risks and benefits, and these trade-offs become particularly important when evaluating treat- ment options for medical conditions that have a signifi- This research was presented at the 2015 American Urological Association Annual Meeting in New Orleans, LA, in May 2015. Financial Disclosure: The authors declare that they have no relevant financial interests. Funding Support: Financial support for this study was provided in part by grants from NIDDK/NIH K12DK083021, the California Urology Foundation, and the UCSF CTSI Resident Research Funding. The funding agreement ensured the authors’ inde- pendence in designing the study, interpreting the data, and writing and publishing the report. From the Philip R. Lee Institute for Health Policy Studies, Department of Urology, UCSF School of Medicine, San Francisco, CA; the Department of Epidemiology & Bio- statistics, UCSF School of Medicine, San Francisco, CA; the UCSF School of Medi- cine, San Francisco, CA; the Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, CA; and the Department of Urology, UCSF School of Medicine, San Francisco, CA Address correspondence to: Lindsay A. Hampson, M.D., Philip R. Lee Institute for Health Policy Studies, Department of Urology, UCSF School of Medicine, 400 Parnas- sus Ave., Box 0738, San Francisco, CA 94143-0410. E-mail: Lindsay.Hampson@ ucsf.edu Submitted: April 19, 2016, accepted (with revisions): July 22, 2016 © 2016 Elsevier Inc. All rights reserved. cant quality-of-life impact. Understanding patient preferences for treatment decisions and considering what aspects of treatment patients value thus become integral to the decision-making process. 1-3 Seeking to understand patients’ preferences helps to move toward shared decision- making between patients and physicians by placing an em- phasis on patient-centered outcomes, which may improve patients’ satisfaction with clinical outcomes by giving them a more realistic understanding of the risk-benefit profile of various treatment options. 2,4 In facing treatment decisions, patients are faced with po- tentially difficult decisions that require weighing the ben- efits and harms of treatment options. Patients may have uncertainty around these decisions given that they have to navigate the potential up- and downsides of several treat- ment choices. Decisional conflict is a term that has been described to reflect the uncertainty that patients have when making a treatment decision. 5 Decisional conflict scales have been developed to capture this phenomenon, and these scales can be utilized as a tool to understand and describe http://dx.doi.org/10.1016/j.urology.2016.07.053