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Survey assessment of the role of stent experience on future stone treatments
Vernon M. Pais, Jr., MD1, Jennifer Bales, MPH2, Elizabeth Stedina, MBA2, Rebecca Smith, BS2.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2The Dartmouth Institute; Geisel School of Medicine, Hanover, NH, USA.
Background. Due to high recurrence rates, stone formers repeatedly confront the need to decide upon surgical intervention. Ureteroscopy has emerged as the most commonly performed procedure for stones, and it was reported that most urologists place stents after ureteroscopy. While it is well recognized that ureteral stents can cause significant postoperative discomfort, the implications of their impact on quality of life have not been fully evaluated. In particular, it is unknown whether prior stent experience may effect decision making for the treatment of stones. To assess this, we developed a survey designed to both elucidate the effect of prior stent experience on future urinary tract stone treatment, and to determine the level of risk of readmission that patients are willing to assume to forgo future stent placement.
Methods: We designed a survey to assess the impact of ureteral stents on quality of life and subsequent treatment decisions. It was reviewed by survey experts, content experts, and then administered to a pilot group of respondents over the last week of February 2016. Internal consistency between questions relating to reported symptoms during stent placement and the question of whether the stent or the stone was worse was assessed with Cronbach’s alpha. Internal consistency of the questions was assessed with Cronbach’s alpha. Interviews were employed to assess face and content validity, and anticipated associations among responses were evaluated to assess construct validity in this pilot trial.
Results: Face and content validity were confirmed via interview of survey methodologists and endourologists, respectively. Of 24 eligible patients, responses were obtained from 17, yielding a 71% response rate. Responses were assessed and strong internal consistency was confirmed (alpha = 0.77). Thirteen answered questions about risk tradeoffs between stent omission and re-admission. 71% of the 7 respondents who felt the stent was worse than the stone (n=5) would omit stent if there was a 7% readmission risk. This decreased to 43% (n=3) if the risk of readmission increased to 20%. For respondents who felt the stent and the stone were the same (n=3), 67% (n=2) chose to omit the stent at a 7% readmission risk. This decreased to 33% (n=1) for the 10% and 15% risk scenarios and none of these respondents were willing to omit the stent in the 20% risk scenario. Respondents who felt the stone was worse (n=2) chose never to omit the stent. Furthermore, those reporting more severe stent-related symptoms were less likely to choose elective surgery for an asymptomatic stone whereas those with less severe symptoms were more likely to choose elective surgery. These findings suggest discriminant construct validity, although these differences were not statistically significant (p=0.164).
Conclusions: Our initial evaluation confirms face and content validity of our survey instrument. Respondents reporting worse stent-related symptoms were less likely to choose elective surgical treatment of a future asymptomatic stone. Given internal consistency and suggestion of discriminant construct validity, this survey may be administered to larger cohorts to assess the role of stent experience in future treatment decisions.
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