Shared decision-making in MIBC: Insights from Angela B. Smith, MD, MS

In an interview about the study “Muscle-Invasive Bladder Cancer Treatment Selection in an Emerging Treatment Era: A Patient Preference Study,” Angela B. Smith, MD, MS, vice chair of academic affairs and a professor of urology at the University of North Carolina, Chapel Hill, emphasized the complexity of patient decision-making and the importance of shared decision-making in urologic oncology.¹

The study found that although most patients preferred to preserve their bladder, many still chose perioperative systemic treatment with cystectomy in fixed-choice scenarios. Smith explained that this apparent divergence reflects the uncertainty patients face and underscores the need for clear communication about the risks and benefits of each treatment option. She also noted that advances in systemic therapies and personalized biomarkers—such as circulating tumor DNA or imaging-based assessments—may soon make bladder-sparing approaches viable for more patients, potentially reconciling these preferences in future clinical practice.

Smith also discussed that nearly 20% of patients reported their physicians did not ask about treatment preferences, highlighting a gap in shared decision-making practices. She attributed part of this issue to time constraints and high clinical workloads, which limit in-depth conversations. To address this, she suggested using pre-visit educational tools, such as WellPrept, to equip patients with foundational knowledge and questions before consultations. This preparation allows clinic time to focus more effectively on aligning medical recommendations with individual values.

Finally, Smith encouraged clinicians to find creative ways to optimize communication and learn from patient experience data. The study’s discrete choice findings—showing that most patients prioritized survival and recurrence reduction and were later tolerant of treatment side effects—can help guide discussions with new patients. Sharing such insights, she noted, reassures patients they are not alone in their decisions and helps clinicians tailor care to what matters most to each individual.

REFERENCE

1. Smith AB, Gore JL, Chisolm S, et al. Muscle-invasive bladder cancer treatment selection in an emerging treatment era: A patient preference study. Urology. 2025 Aug 12:S0090-4295(25)00767-8. doi:10.1016/j.urology.2025.08.013