Patients' perceptions on active surveillance for the treatment of small renal masses.

Background: Most patients diagnosed with a small renal mass (SRM) are treated with definitive treatments such as surgery or thermal ablation. Given that some SRMs are benign or have low metastatic potential, active surveillance seeks to reduce the overtreatment and the potential complications. Active surveillance is an alternative that is being increasingly considered. Active surveillance has already been shown to be effective, but there is a current knowledge gap regarding patients' perceptions of active surveillance and factors influencing their decision.

Objective: To describe patients' perceptions of active surveillance of SRMs and to identify factors influencing those perceptions.

Design, Setting, And Participants: This multicenter descriptive qualitative study recruited patients diagnosed with a renal mass from three institutions, using purposeful sampling. Data were collected using focus group discussions, which were recorded and transcribed. A mixed thematic analysis was performed.

Results: Six focus group discussions were conducted with a total of 24 participants. Participants perceived active surveillance as an option to avoid definitive treatments and their potential risks. Active surveillance was, however, perceived to be a temporary solution that would affect their chance of survival and their quality of life. Seven factors were documented as influencing patients' perceptions of active surveillance, the most important being their physician's recommendation.

Conclusions: Perceptions of patients with SRMs toward active surveillance varies among individuals. The development of more patient-oriented information tools is needed to educate patients, to reduce physician influence on the decision-making process and to ensure that the patients' decision reflects their own values and preferences.