University of Montreal
Development of a New Canadian Endourology Group Stent Symptom Score (CEGSSS)
Naeem Bhojani1, Jason Y. Lee2, Shubhadip (Shubha) K. De3, Andrea Lantz Powers4, Sri Sivalingam5, Michael Ordon2, Kymora Scotland7, Sero Andonian6, Ben H. Chew8.
1Urology, University of Montreal, Montreal, QC, Canada; 2Urology, University of Toronto, Toronto, ON, Canada; 3Urology, University of Alberta, Edmonton, AB, Canada; 4Urology, Dalhousie University, Halifax, NS, Canada; 5Urology, Cleveland Clinic, Cleveland, OH, United States; 6Urology, McGill University, Montreal, QC, Canada; 7Urology, University of California Los Angeles, Los Angeles, CA, United States; 8Urology, University of British Columbia, Vancouver, BC, Canada
Canadian Endourology Group.
Introduction: Placement of a ureteral stent is a common urological intervention that can significantly impact QoL. The ureteral stent symptom questionnaire (USSQ) has been used since its development in 2003 but its length hinders its use in clinical practice. Therefore, we sought to develop a new, shorter, practical and validated tool.
Methods: Phase 1: Using the USSQ as a starting point, 9 Canadian Endourology Group (CEG) members and 21 patients evaluated each item of the USSQ (Likert scale 1 to 5) to determine its importance/relevance in assessing symptoms associated with a ureteral stent. All accepted items were than discussed with face-to-face meetings. Phase 2 (Pilot trial): Patients undergoing stent placement completed the newly developed CEGSSS in addition to a short survey evaluating the tool itself. 5 rounds of 5 patients, with modifications of the CEGSSS based on feedback after every round was anticipated.
Results: Phase 1: After consultation with patients and CEG experts, items were accepted if the mean patient or expert rating was ≥4.0 (out of 5) with a SD of ≤0.75. Questions with mean patient or mean expert ratings of ≥4.0 but SD ≥0.75 or with divergent results between patients and experts were flagged for discussion. Those items that did not meet these requirements were rejected. The final CEGSSS contains 15 questions divided into 3 domains: Urination (8 Q), Pain (3 Q) and QoL (2 Q). Phase 2: 16 patients were recruited. After 3 rounds of patient feedback, no new feedback was received and therefore this process was deemed complete (Table 1). Median time to complete the CEGSSS was 7 minutes (2-20 minutes). 2/16 patients required assistance to complete the questionnaire, but all patients rated it as easy to navigate. Mean level of difficulty was 1.75/5.
Conclusions: Through a process of expert and patient consultation and a pilot trial, a new stent symptom questionnaire was developed that is short, easy for patients to understand and clinically relevant. The next step will be external validation of the newly developed CEGSSS.