Decision Regret Related to Urinary Diversion Choice Among Cystectomy Patients.

Abstract

PURPOSE\nPatients undergoing cystectomy for bladder cancer can choose to have an ileal conduit or 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 neobladder vs. ileal conduit.\n\n\nMATERIALS AND METHODS\nWe analyzed data from a longitudinal cohort study of patients who underwent cystectomy from 2013-2015, using multivariable linear regression to examine associations of urinary diversion method (neobladder vs. ileal conduit) with decision regret (measured with the Decision Regret Scale) at 6 and 18-months post-cystectomy. Covariates included demographic and clinical characteristics, health care utilization and complications post-cystectomy, quality of life (QOL), and factors related to the decision-making process (informed and shared decision-making, goal concordance).\n\n\nRESULTS\nOf 192 patients in our cohort, 141 received ileal conduit and 51 received neobladder. We did not observe significant differences in DRS score between neobladder and ileal conduit patients at either time point (6 months: b=-1.28, 95% CI [-9.07, 6.53]; 18 months: b=-1.55, 95% CI [-12.48, 9.38]). However, informed decision-making was negatively related to decision regret at 6 months, b=-13.08, 95% CI [-17.05, -9.11], and 18 months, b=-8.54, 95% CI [-14.26, -2.63]. QOL was negatively associated with decision regret at 18 months, b=-5.50, 95% CI [-8.95, -2.03].\n\n\nCONCLUSIONS\nCystectomy patients who felt more informed about bladder reconstruction options experienced less regret, independent of method selected. Efforts to inform and prepare patients for the decision about bladder reconstruction may help to prevent decision regret.