The Current Evidence for Factors that Influence Treatment Decision Making in Localized Kidney Cancer: A Mixed Methods Systematic Review

PURPOSE: With a growing number of treatment options for localized kidney cancer, patients and health care professionals have both the opportunity and the burden of selecting the most suitable management option. This mixed method systematic review aims to understand the barriers and facilitators of the treatment decision making process in localized kidney cancer. MATERIALS AND METHODS: We searched PubMed®, Embase® and Cochrane Central databases between January 1, 2004 and April 23, 2020 using the Joanna Briggs Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We identified 553 unique citations; of these, 511 were excluded resulting in 42 articles included for synthesis. The Purpose, Respondents, Explanation, Findings and Significance and the Strengthening the Reporting of Observational Studies in Epidemiology checklist was applied. RESULTS: The key themes describing barriers and facilitators to treatment decision making were identified and categorized into 3 domains: 1) kidney cancer specific characteristics, 2) decision maker related criteria and 3) contextual factors. The main facilitators identified within these domains were size at diagnosis, age, comorbidities, body mass index, gender, nephrometry scoring systems, biopsy, socioeconomic status, family history of cancer, year of diagnosis, geographic region and practice pattern. The key barriers were race, gender, patient anxiety, low confidence in diagnostic and treatment options, cost of procedure, and practice patterns. CONCLUSIONS: Future interventions designed to improve the decision making process for localized kidney cancer should consider these barriers and facilitators to ensure a better patient experience.