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Impact of the COVID-19 Pandemic on Patient Preferences and Decision Making for Symptomatic Urolithiasis.

  • Jiang, Tommy1, 2
  • Osadchiy, Vadim1, 2
  • Weinberger, James M1
  • Zheng, Michael H3
  • Owen, Michael H4
  • Leonard, Sarah A5
  • Mills, Jesse N1
  • Kachroo, Naveen6, 7
  • Eleswarapu, Sriram V1, 2
  • 1 Division of Andrology, Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
  • 2 Consortium for Health Activity on Social Media, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
  • 3 Department of Statistics, University of California, Berkeley, California, USA.
  • 4 Department of Computer Science, College of Liberal Arts, University of Iowa, Iowa City, Iowa, USA.
  • 5 College of Letters and Sciences, Carleton College, Northfield, Minnesota, USA.
  • 6 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
  • 7 Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.
Published Article
Journal of Endourology
Mary Ann Liebert
Publication Date
Aug 01, 2021
DOI: 10.1089/end.2020.1141
PMID: 33478351


Background: Pandemic restrictions have changed how patients approach symptomatic kidney stones. We used a mixed-methods digital ethnographic approach to evaluate social media discussions about patient concerns and preferences for urolithiasis care during the COVID-19 pandemic. Materials and Methods: We retrospectively analyzed kidney stone-related discussions on a large social media platform using qualitative analysis and natural language processing-based sentiment analysis. Posts were mined for demographic details, treatments pursued, and health care encounters. Pre-COVID-19 (January 1, 2020-February 29, 2020) and COVID-19 (March 1, 2020-June 1, 2020) posts were extracted from the popular online Reddit discussion board, "r/KidneyStones," which is dedicated to discussions related to urolithiasis. Results: We extracted n = 649 posts (250 pre-COVID-19, 399 COVID-19); 150 from each cohort underwent thematic analysis and data extraction. Quantitative sentiment analysis was performed on 418 posts (179 pre-COVID-19, 239 COVID-19) that described stone-related decision making before intervention. Notable discussion themes during COVID-19 focused on barriers to care and concerns about stone management. Discussants exhibited more negative and anxious tones during COVID-19, based on sentiment analysis (p < 0.01). Patient preferences shifted away from in-person visits and procedures (p < 0.001). Mean reported stone size among those visiting emergency room (ER) increased from 5.1 to 10.5 mm (p < 0.001). The proportion of discussants preferring conservative management with stones ≥10 mm increased (12.5% pre-COVID-19 vs 26% during COVID-19, p = 0.002). Opioid mentions increased from 9% to 27% of posts (p < 0.001) and were most associated with conservative management discussions. Conclusions: Online discussion forums provide contemporaneous insight into patients' experiences during a time when traditional patient-centered research methodologies are limited due to social distancing. During the pandemic, patients with symptomatic kidney stones expressed anxiety regarding outpatient encounters and reluctance toward procedural intervention. Patients opted instead for at-home conservative treatment beyond clinical guidelines and reserved ER visits for larger stones, potentially causing self-harm. Opioid discussions proliferated, an alarming consequence of the pandemic.

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