Patient-Centered Decision-Making for Management of Small Renal Tumors - Supplement

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Project Summary The current treatment paradigm for small kidney tumors (≤ 4 cm) has resulted in worsened overall survival despite earlier detection and aggressive treatment with surgical resection. This lack of improved outcomes may be due to the indolence of most kidney tumors and harms of surgery in this generally older population. Although the majority of these small kidney masses are malignant, a small minority of tumors metastasize and approximately 20% resected tumors are benign. Since current guidelines recommend that comorbidities should be weighed when selecting treatment, and that patients with chronic kidney disease are particularly at risk of worsened survival after surgery, decision-making must include balanced discussions to reduce over-treatment. As an abdominal radiologist and health outcomes researcher, I have obtained my MD and a Master of Science degree concentrated in comparative effectiveness research methods. The Departments of Population Health and Radiology within New York University Medical Center offer the mentoring and resources to position me for successful health services research in kidney tumor management as an independent investigator. A team of experts in medical decision-making, decision aids, radiology, oncology and urology have and will continue to guide my project and career development. During the proposed period of support, I will complete coursework in measurement of patient preferences for decision making and tutorials in qualitative analysis, serving both this project and my career development. I will also complete training activities for grant writing and clinical trials design toward the goal of directly translating the proposed work to an R01 application that tests the effectiveness of the proposed decision aid for patients with small kidney tumors. In the current proposal, I will build a new web-based patient decision tool for small kidney tumors that employs more effective and complete educational techniques and decision support features than a pamphlet format. We will embed our published decision-analytic model within the web-based tool, and enable assessment of treatment options according to patient comorbidities (e.g. chronic kidney disease) and tumor features that affect the benefits and harms of each option. Represented management strategies include the most common treatment of partial nephrectomy, as well as less invasive percutaneous ablation, surveillance imaging, and biopsy. This interactive tool will aid understanding of early stage kidney tumors, communicate personalized harms/benefits, and elicit patient preferences for treatment attributes. Evidence-based risk communication techniques and expert committee review will ensure it is designed for shared decisions, pursuant to the International Patient Decision Aids Standards. We will then complete a pilot study for preliminary data on usability, improvement in patient knowledge, and shared decision making. Ultimately, this timely tool may help actualize patient-centered decision-making for management of small kidney tumors.