Role of Patient-Physician Dialogue in Selecting the Type of Urinary Diversion

Abstract

Introduction: We analyze patient-physician dialogue prior to radical cystectomy (RC) when choosing the type of urinary diversion (UD). Methods: 132 patients operated by one surgical team between 2003 and 2005 were included. Physician’s recommendation, patient’s decision and UD (neobladder (NB) or ileal conduit (IC)) performed were analyzed. Patients were grouped based on age, considering that age is often a limiting factor for NB. Results: When offered either NB or IC, 85% (49/58) in group I (<70 years) and 55% (12/22) in group II (≧70 years) elected NB. An IC was suggested for 16% (11/69) in group I and 65% (41/63) in group II. Six patients (2 in group I, 4 in group II) wanted a NB even though an IC was suggested. Conclusions: Counseling patients is important. When an IC was suggested, over 80% accepted this advice. When both were offered, younger patients usually elected a NB. Older patients preferred an IC.

Choosing between Orthotopic Neobladder and Ileal Conduit after Radical Cystectomy: Tools for Assessing Patient-Specific Characteristics and Enhancing the Decision-Making Process—A Review of Current Studies

“…Design. A prospective study from the USA described the impact of patient–physician dialogue in selecting UD [ 19 ]. Patients.…”

“…In the second group, we found four studies focusing on shared decision-making and a more personalized approach to the patient while choosing UD, involving studies describing personality [ 16 ], patients’ values and goals [ 17 , 18 ], and role of patient–physician dialogue in the context of choosing UD [ 19 ]. The main drawbacks of all four studies are small sample sizes, but most of all, the correlations between all assessed features and their impact on choice of UD were not evaluated.…”

“…Assessing patient personality and preferences in the context of choosing a UD seems to be helpful in selecting patients that need more assistance in decision-making, but without giving any guidance for physicians on which UD to suggest [ 16 ]. This is an especially important issue, as in one study the authors demonstrated that more than 80% of patients accept physician advice related to UD [ 19 ]. Two articles presented questionnaires (ten-item decision dissonance scale and BRSQ) assessing patient goals and the aspects of reconstruction that were crucial to them in making their decision related to UD, however, questionnaires were not validated and designed for study purposes [ 17 , 18 ].…”

“…Sufficient information of patients whose preferences are considered is associated with lower rates of decision regret related to UD [ 24 ]. Patients mostly submit to the physician’s suggestion, which shows how important and responsible a role they have in preoperative counseling [ 19 ]. Therefore, the ability to distinguish between patients who want to delegate decision-making to the doctors and those who want to participate in this process (e.g., by analyzing patients’ personality or anxiety level) is crucial [ 16 ].…”