Presentation Authors: Nicholas B Koch*, Elaine K Kearney, Catherine Wiener, Gary G. Koch, Leslie D Lorbacher, Davis Viprakasit, Chapel Hill, NC
Introduction: Renal colic is one of the most common and concerning complaints for patients with symptomatic kidney stones. The patient perspective historically has not been considered in the evaluation of treatment outcomes in kidney stone surgery. The Patient Centered Outcomes Questionnaire is a validated tool developed for the investigation of patient perspectives in chronic pain. Using a modified PCOQ, we investigated the difference in patient defined outcomes in pain and non-pain focused patients following stone surgery.
Methods: 59 symptomatic patients undergoing either ureteroscopic or percutaneous stone surgery participated in a longitudinal assessment by completing a modified, stone-specific Patient Centered Outcomes Questionnaire (sPCOQ) prior to surgery and at their routine postoperative follow-up. Patients' expected, desired, and success levels of pain symptoms following surgery were determined. Responses were then compared between pain-focused and non-pain-focused patient subgroups as defined by patients' determination of importance of pain control.
Results: The cohort was 68% female and had a mean age of 54.9 years. A positive stone history was reported in 69% and was significantly higher in the pain-focused population. Pain-focused patients required a larger reduction in symptoms to meet their outcome criteria for desired, expected, and success levels though these defined levels were all relatively similar. Non-pain focused patients also desired the greatest reduction in pain. However, these patients expected and would accept lower levels of improvement in symptoms to consider treatment successful. Overall, all patients had a significant improvement in pain symptoms following surgery. However, patients who rated pain as their primary criteria for success were significantly less likely to reach their expected outcome level for pain (p < 0.05) and overall, pain-focused patients were less likely to meet their defined success criteria.
Conclusions: The sPCOQ provides a valuable tool in assessing patient perspectives in treatment outcomes for pain symptoms in kidney stone patients undergoing surgery. Pain-focused patients have stricter criteria for their desired, expected, and successful outcomes following kidney stone surgery. Additionally, they may elevate all outcome criteria more similarly to their desired levels. As a result, these patients may be less likely to reach their treatment goals. This suggests kidney stone patients with a predominant pain complaint could require more attention and counseling regarding treatment outcomes and realistic expectation management following surgery.
Source of Funding: National Institute of Diabetes, Digestive and Kidney Diseases. This work was supported by grant number T35-DK007386 from the National Institutes of Health