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No AccessJournal of UrologyAdult Urology1 Jan 2020

Decision Regret Related to Urinary Diversion Choice among Patients Treated with Cystectomy

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    Purpose:

    Patients who undergo cystectomy due to bladder cancer can elect an ileal conduit or a neobladder for urinary diversion. Decision regret related to this choice is an important and undesirable patient reported outcome. Our objective was to compare the severity of decision regret experienced by patients with a neobladder vs an ileal conduit.

    Materials and Methods:

    We analyzed data from a longitudinal cohort study of patients who underwent cystectomy from 2013 to 2015. We applied multivariable linear regression to examine associations of the urinary diversion method (neobladder vs ileal conduit) with decision regret measured with the DRS (Decision Regret Scale) 6 and 18 months after cystectomy. Covariates included demographic and clinical characteristics, health care utilization and complications after cystectomy, quality of life and factors related to the decision making process, including informed and shared decision making, and goal concordance.

    Results:

    Of the 192 patients in our cohort 141 received an ileal conduit and 51 received a neobladder. We observed no significant difference in the DRS score in patients with a neobladder vs an ileal conduit at 6 or 18 months (b=–1.28, 95% CI –9.07-6.53, vs b=–1.55, 95% CI –12.48-9.38). However, informed decision making was negatively related to decision regret at 6 and 18 months (b=–13.08, 95% CI –17.05-–9.11, and b=–8.54, 95% CI –4.26-–2.63, respectively). Quality of life was negatively associated with decision regret at 18 months (b=–5.50, 95% CI –8.95-–2.03).

    Conclusions:

    Patients treated with cystectomy who were more informed about bladder reconstruction options experienced less regret independent of the method selected. Efforts to inform and prepare patients for the bladder reconstruction decision may help prevent decision regret.

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    The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.

    No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article.

    Editor's Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 212 and 213.

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