Exploring Management Preferences Among Patients with Small Renal Masses: Results from a Pilot Study.

Background and objective: Most patients diagnosed with a small renal mass (SRM) undergo definitive treatment, but active surveillance may be offered as an alternative. Our aim was to determine patient preferences regarding management of their SRM.

Methods: In this multicenter prospective pilot study, we conducted structured online interviews with patients with a new SRM diagnosis. During the interviews, patients reviewed outcome data and stated their preference for definitive treatment (thermal ablation vs partial nephrectomy). Then the patients reviewed hypothetical scenarios in a ping-pong approach and chose the maximum change in the probability of death from kidney cancer they would be willing to accept in order to decline definitive treatment.

Key findings and limitations: Of the 41 participants interviewed, 71% (n = 29) preferred thermal ablation over surgery. While the median maximum increase in the probability of death from kidney cancer that patients were willing to accept to decline definitive treatment was 0.1% (interquartile range 0.1-2.5%) at 5 yr, 27% of patients reported a threshold ≥2%. Most patients (97%) preferred to review data in the form of a "reduction in the risk of death", rather than an "increase in the risk of death", or expressed no preference. Limitations include the small sample size.

Conclusions and clinical implications: This pilot study demonstrates the feasibility of an innovative approach for evaluating the preferences of patients with SRMs and establishes a robust methodology for future studies. Results highlighted a strong preference for thermal ablation and for presenting data in terms of the reduction in mortality risk. Larger studies are required to validate our findings.