The goal of this clinical trial is to compare preoperative information and patient experience using a personalized versus a generic 3D printed models of patients' tumoral kidney before and after nephron-sparing surgery. The main outcome measure will be based on semi-structured interviews with the patient and the carers.
The use of tools to decrease anxiety and enhance understanding prior to surgery is a key point in comprehensive care that is way not enough promoted for now. A pilot study from 2015 demonstrated the benefits of using personalized 3D-printed kidney models as educational mediation tools during the pre-operative consultation of patients scheduled for robot-assisted partial nephrectomy. The patient's understanding of his pathology and of the surgery was thus facilitated, leading to greater satisfaction during treatment. For personalized medicine, it is important to consider the heterogeneity in culture and social backgrounds of patients in the doctor-patient relationship. Measuring health literacy help to identify and describe this heterogeneity in patient profiles. Patients with low literacy levels have higher levels of anxiety, particularly regarding surgery, and poorer post-operative recovery. Some studies highlight the importance of improving patient understanding with strategies to improve patients' health literacy and information provided by carers. The goal of this study is therefore to investigate the benefits of using a personalized 3D-printed kidney model versus a generic 3D-printed kidney model as a mediation tool, all along the care pathway, on patients' experience and their interactions with carers, before and after partial nephrectomy. To achieve this aim, 60 patients planned for robot-assisted laparoscopic partial nephrectomy will be randomized, in a 1:1 ratio, between the use of a personalized 3D kidney model and a generic 3D kidney model. 3D models will be presented to the patients according to the allocated study group during a preoperative education consultation. All patients will complete questionnaires about their health literacy level, their knowledge of kidney anatomy and tumor and their satisfaction about the using 3D-printed kidney models as educational mediation tools. Semi-structured interviews will be conducted at three different times: between the first consultation with the surgeon and the preoperative education consultation, between this second consultation and the surgery and after the post-operative consultation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
39
Before surgery, during a preoperative therapeutic education consultation, a personalized 3D models will be presented to the patients according to the allocated study group
Before surgery, during a preoperative therapeutic education consultation, a generic 3D models will be presented to the patients according to the allocated study group
CHU de Bordeaux
Bordeaux, France
RECRUITINGQualitative assessment of patient experience 1
Patient experience will be measured by a set of element including observations and 3 questionnaires described in outcome 1, outcome 2, outcome 3. Measurement of the progression in mean health literacy questionnaire score HLSEU-Q16 this questionnaire is a short version version of the European Health Literacy Survey Questionnaire (Sørensen et al., 2013), based on a model including 4 health information processing skills: accessing, understanding, evaluating and applying application of health information. The Items are scored from 'Strongly Disagree' to 'Strongly Agree', and from 'Cannot Do' to 'Very Easy'. The total score is produced by summing all items
Time frame: between baseline and Day15 post-op
Qualitative assessment of patient experience 2
Patient experience will be measured by a set of element including observations and 3 questionnaires described in outcome 1, outcome 2, outcome 3. Measurement of the level of understanding of renal anatomy and surgical issues using the Bernhard et al. questionnaire. The knowledge questionnaire ( Bernhard 2016) consists of 4 parts: basic kidney physiology, basic kidney anatomy, tumor characteristics and planned surgical procedure. The patient answers 'False' , 'True' or 'Don't know'. The scores are calculated in each part by calculating the numbers of correct answers . These dimensions will be studied before and after the presentation of the model, and compared according to the model used.;
Time frame: between baseline and Day15 post-op
Qualitative assessment of patient experience 3
Patient experience will be measured by a set of element including observations and 3 questionnaires described in outcome 1, outcome 2, outcome 3. Patient satisfaction is measured using the satisfaction questionnaire adapted from the Bernhard 2016 study. This measures how well the three-dimensional printed kidney model helped patients in learning " basic notions " about the kidney, and improving their understanding of : the disease, the scheduled surgery and the risk of complications related to the surgery. Each of the four dimensions is rated by a 10-point score ranging from 1 "no help at all" to 10 "great help". The average of the scores per dimension and an overall satisfaction score will be calculated and compared between the groups.
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Time frame: between baseline and Day15 post-op
Description of interactions between carers and patients
The description will be done according to the 3 D model used, specifying the aproach based on individual semi-directive interviews exploring patient experience, health education and health literacy as well as the vocabulary and content of the discourse employed.
Time frame: between baseline and Day15 post-op
Comparison of the evolution and frequency of terms used by patients in the 2 groups during their care.
The comparison will be done by evaluation of the evolution and frequency of terms used by patients : terms related to the pathology, the kidney model used, interactions with professionals in the care circuit
Time frame: between baseline and Day15 post-op
Studying the use of the 3D-printed kidney model introduced during the medical information consultation up to the post-operative visit by describing the life of the model throughout the entire care process
Time frame: between baseline and Day 15 post-op
To study the level of understanding of renal anatomy and surgical issues according to the type of tool (personalized vs generic 3D printed model)
Level of understanding measured by the Bernhard et al questionnaire. This questionnaire consists of 4 parts: physiological and anatomical dimensions, knowledge of the disease and tumor characteristics, understanding of the surgical procedure and associated complication risks. These dimensions will be studied before and after the presentation of the model, and compared according to the model used. The final part of the questionnaire, based on an assessment of patient satisfaction, will be presented at the end of the post-operative consultation period
Time frame: baseline ; between D-1 and Day-15 from surgery ; Day 15 post-op
Comparison of the level of health literacy between the two groups at different times with changes in the average score on the literacy questionnaire (HLSEU-Q16: European Health Literacy Survey Questionnaire)
This questionnaire is a short version version of the European Health Literacy Survey Questionnaire (Sørensen et al., 2013), based on a model including 4 health information processing skills: accessing, understanding, evaluating and applying application of health information . Patients respond on a 4 scale ranging from "very easy" to "very difficult". The overall score scales from 0 to 16 points. This score is used to determine 3 levels of literacy: unsatisfactory (0-8), average(9-12) and satisfactory (13-16).
Time frame: baseline ; Day-30 post-op
Description of the changes perceived by carers in patients management in both group
Qualitatively assessment of changes in practices following the integration of 3D models into the department's practices. This analysis will be based on interviews with professionals, describing their relationship with patients and their families.
Time frame: between baseline and year 1 post baseline