PREDICT kidney feasibility study
Research type
Research Study
Full title
A feasibility study of incorporating the PREDICT Kidney risk communication tool into clinical care for patients who have undergone surgery for newly diagnosed localised renal cell carcinoma
IRAS ID
343656
Contact name
Juliet Usher-Smith
Contact email
Sponsor organisation
Cambridge University Hospitals NHS Foundation Trust
ISRCTN Number
ISRCTN17719284
Duration of Study in the UK
0 years, 8 months, 31 days
Research summary
Research Summary:
Kidney cancer is diagnosed in more than 4000 people annually in the UK. If the cancer has not spread outside the kidney, most patients will have surgery to remove it. It is recommended that doctors should estimate the risk of kidney cancer coming back after surgery for each patient, to help them decide appropriate follow-up. We have developed a new online tool, PREDICT Kidney, to help clinicians with this. This study aims to test this tool with a small number of patients and clinicians.
We will invite adults from hospitals in England and Scotland who have had surgery for kidney cancer to take part in the study after they have had surgery and before their first follow-up consultation. Around 60 participants will be allocated into two groups. Those in the first group will have the standard current level of care. This is a face-to-face clinic appointment where they are informed of the estimated risk of the cancer returning (i.e. low, intermediate or high) and given a follow-up plan based on that risk. For those in the second group the clinicians will use the new tool to give participants an estimated percentage risk of the cancer returning alongside the corresponding estimated percentage risk of dying from other causes. The participants will also be given a printout of those estimated risks. We will ask to record some consultations in both groups and patients will then be given questionnaires before, immediately after and 3 months after their appointment. We will also speak to a sample of patients in the second group and healthcare professionals to seek feedback regarding the tool.
We will use the findings from this study to improve the tool and plan a larger study to test whether using it improves patients’ understanding of their risk of recurrence and planned follow-up.
Summary of Results:
What is the problem?
In the UK, kidney cancer is the 6th most common cancer and diagnosis of kidney cancer is on the rise. Many patients with kidney cancer have surgery to remove their cancer. For 1 in 3 patients their kidney cancer will come back in the future. The chance of this happening varies from person to person depending on their cancer. Patients are monitored after surgery so that any cancers can be found early. Patients with larger or more aggressive cancers are monitored more often than patients who have smaller or less aggressive cancers. In the past, the amount of information given to patients about the chance of their cancer coming back has been different depending on which hospital they went to. Some patients found the information they were given hard to understand.What is PREDICT-Kidney?
The PREDICT-Kidney tool was created by researchers with input from patients, the public, and doctors. The tool was made to help patients and doctors talk about the risk of kidney cancer coming back and to help patients understand their follow-up monitoring. The tool contains information about the chances of kidney cancer coming back and can be printed out for patients to take home.What question does the research answer?
The purpose of the research was to test the PREDICT-Kidney tool in follow-up appointments for patients who have had surgery to remove their kidney cancer. We wanted to understand their thoughts and experiences of using the tool. We also wanted to understand practical problems with testing the PREDICT-Kidney tool with more patients.How was the study done and who was involved?
This study was led by researchers and doctors from the University of Cambridge. It took place at three hospitals, two in England and one in Scotland. They compared the understanding and experiences of patients whose doctors had used the PREDICT-Kidney tool with patients whose doctors had not used it. Patients filled in questionnaires to tell us about their views, and some took part in an interview with a researcher. The researchers also interviewed some of the doctors who had used the PREDICT-Kidney tool with their patients. The consultations were recorded to check that the tool was being used properly and to find out if using it made appointments longer.51 patients took part in the study. 26 of these patients had a normal follow-up consultation and 25 patients had consultations where the doctor had used the new PREDICT-Kidney tool.
Some patients who were invited to take part chose not to for a variety of reasons, such as:
• They thought the study would be too much effort
• They had not read the information about the study before their appointment
• They did not want to complete questionnaires
• They felt overwhelmed or worried.What were the findings?
Most patients who experienced the PREDICT-Kidney tool felt satisfied with the information that was given to them. Most patients liked the tool and found that the different diagrams helped them to understand the chances of their cancer coming back in the future. 9 out of 10 patients were very or extremely satisfied with the way information was given to them and the tool did not increase feelings of anxiety. Patients whose doctors used the PREDICT-Kidney tool were able to remember the risk of their kidney cancer coming back more accurately than patients whose doctors did not.Patients had mixed feelings when talking about the chances of dying from other causes. Some older patients thought this was a helpful way to put their chances of having another kidney cancer into perspective. Some younger patients did not think talking about other causes of death was relevant for them.
The doctors who used the PREDICT-Kidney tool with their patients thought the tool was useful and easy to use. Some doctors thought the tool included too much information to cover in one appointment and the tool made the appointment slightly longer. They did not always explain every part of the PREDICT-Kidney tool to their patients.
Why does this matter?
Making sure that patients have access to accurate and consistent information about the chance of their kidney cancer coming back in the future is important to reduce anxiety and help people to understand the follow-up monitoring they need to make sure any future kidney cancer is detected early. The research team now want to make the PREDICT-kidney tool widely available for doctors to use in follow-up appointments in the future. The tool could also be developed to help patients make decisions about additional treatments.REC name
East of England - Cambridge South Research Ethics Committee
REC reference
24/EE/0216
Date of REC Opinion
23 Oct 2024
REC opinion
Further Information Favourable Opinion