Introduction: At a complex time in their life, a patient with bladder cancer faces a difficult process that is paramount to their quality of life after radical cystectomy (RC). Shared decision-making, where patients are informed of the complexities, risks and benefits of each of the three urinary diversion options is critical. Our objective was to understand urologist and patient perspectives on issues influencing decision for urinary diversion and develop a decision aid. Methods: Urologists (n=11), all performing high volume RC, from across the country were recruited and interviewed for 30-60 minutes about their workflows, patient decision making, and ideal decision aid. Patients (n=14) currently undergoing or recently undergone RC were recruited, interviewed 30-60 minutes about their decision making process and ideal decision aid (content, format, delivery, value). All interviews were audio recorded, professionally transcribed, and uploaded to Atlas.ti for coding. Coding was done by a qualitative trained research collaborator using an inductive codebook developed by the team through iterative review of transcripts. There was double coding done in 20%. Results: Three major themes were identified and used for the development of a decision aid for urinary diversion after RC. (1) The first theme focused on weighing of medical considerations, urologists weighted this consideration towards surgical risk, comorbidities and complications. Patients were concerned with maintenance and lifestyle. Urologists and patients thought age would impact recovery. (2) The second theme was the misalignment of body images and activity limitations. Urologists felt patients have a misconception that certain diversions will limit activity. Although patients perceived that certain diversions will limit activity, they were more concerned about the 'best fit.' Urologists perceive body image as a 'look' whereas patients felt it was more about feel and hygiene. Patients want help imagining life with the diversion. (3) The third theme was considerations about maintenance. Urologists felt items such as catherization avoidance was secondary to discomfort, while most patients actually disliked the idea due to increased risk of infections. Patients were concerned about their desire to maintain diversion, but urologists were concerned with the ability to perform maintenance. Conclusions: Urologists and patients have biases that can be addressed by working through a decision aid to align and activate conversation. Future work and testing is necessary for the newly developed decision aid. SOURCE OF Funding: Urology Care Foundation
