ABSTRACT
OBJECTIVE
To evaluate the perioperative decision-making process, post-operative decision regret
and reflection on the peri-operative experience of patients undergoing radical cystectomy
and urinary diversion through patient interviews.
METHODS
Patients identified as having undergone radical cystectomy for malignancy were interviewed
6-24 months from the time of surgery and stratified by diversion type. Following written
consent, interviews were conducted either in person or over the phone using a semi-structured
script. Patients were asked 9 open-ended questions, with additional unscripted follow-up
questions based on themes raised by the patient. The interviews were reviewed for
common themes, preferences, and recommendations.
RESULTS
A total of 13 interviews were conducted. No patient expressed decision regret about
their choice of urinary diversion. Ten out of 13 interviewees specifically stated
that they had adequate information about diversion options pre-operatively, none felt
they did not have adequate pre-operative counseling. One area identified as improvable
was postoperative counseling- specifically, for ostomy appliances, catheters, or irrigation.
The most striking recurrent theme was the desire for a “buddy system” in which patients
could contact and maintain discussion about their surgical experience with an experienced
patient. The overall impression was that this system would be most useful in the recovery/maintenance
phase rather than in the pre-operative decision-making process.
CONCLUSION
This data furnishes a basis to develop more accessible and effective counseling and
highlights the need to concentrate on post-surgical maintenance care, including management
of urostomy appliances, catheters, and reinforcing irrigation technique.
Abbreviations:
IC (Ileal conduit), UD (urinary diversion), NB (neobladder), IP (Indiana pouch), BCAN (Bladder Cancer Advocacy Network)To read this article in full you will need to make a payment
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References
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American Cancer Association. Key Statistics for Bladder Cancer. 2020, January 8.
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Article info
Publication history
Published online: January 18, 2021
Accepted:
January 5,
2021
Received:
September 20,
2020
Footnotes
Source of Funding: Grant from NIH/NCI under award number P30CA016672 and used the Shared Decision Making Core.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
