<p>What Do Men with Lower Urinary Tract Symptoms Expect from a Urologist in Secondary Care?</p>

Abstract

Purpose To identify the expectations of men with LUTS referred to a urologist and to study the association between those expectations and satisfaction with the care provided. Methods In this prospective cohort study, adult men with LUTS completed a questionnaire before their first outpatient appointment, and again at 6 and 12 weeks. The questionnaires included IPSS and OABq-SF, and self-constructed questions on patient expectations, outcome of expectations and satisfaction. Results Data from 182 participants showed positive expectations about the urologist performing examinations, providing explanations and finding the underlying cause, but mostly neutral expectations for treatment plans and outcomes. Positive treatment expectations were associated with positive expectations about outcomes after physiotherapy, drug treatment and surgery. Higher symptom scores and age were associated with higher expectations about drug treatment. Expectations were subjectively and objectively fulfilled for 66.4% and 27.3%, respectively. Symptom improvement (decrease in IPSS scores) was significantly more in men with objectively fulfilled expectations than in men with no unfulfilled expectations. No significant difference was present between men with subjectively fulfilled expectations and men with unfulfilled expectations. However, satisfaction was significantly higher for patients with subjectively fulfilled expectations at 6 and 12 weeks compared with those who had unfulfilled expectations. Conclusion Most men referred to a urologist with LUTS do express clear expectations about treatment in secondary care. Patients with higher expectations for treatment outcomes are more likely to expect to receive that treatment. Satisfaction with the care of a urologist is also higher when patients self-report that they receive the treatment they expected.

A Systematic Review of Patients’ Values, Preferences, and Expectations for the Diagnosis and Treatment of Male Lower Urinary Tract Symptoms

“…Despite this, the majority would undergo video urodynamics again if medically recommended. Men expect to be prescribed pharmacological treatments for LUTS (the single most common answer; 43%), especially if their symptoms are severe, and expect pharmacological treatments to reduce voiding symptoms [36]. Rapid symptom improvement: 4 studies reported on the proportion of patients preferring a medication with rapid symptom relief [15,22,32,33]; 62-97% preferred a treatment that provided rapid improvement in symptoms (within a few weeks to months) [15,22].…”

“…the management of LUTS/BPO (Table 3) [26,34,36]. Most men (63%) favoured less risky options with a preference for watchful waiting over pharmacological or surgical treatment unless symptoms were at least moderately severe [26].…”

“…Fifteen studies reported on expectations or preferences related to pharmacological treatment [15,[17][18][19][20]22,27,28,[30][31][32][33][34]36,40]. Principal themes related to (1) efficacy of treatment, (2) effect on stabilising the underlying disease process, (3) type of adverse events, (4) prevention of complications of benign prostatic hyperplasia, and ( 5) burden/cost of treatment (Tables 3 and 5).…”

“…One cohort study reported that men (especially older men or those with more severe LUTS) expected to be prescribed pharmacological treatment and expected that this treatment would improve their voiding LUTS [36]. Two discrete choice experiments [27,40] reported that preferences for improvement in urgency incontinence were almost four times greater than that for nocturia (willingness to pay £25.30 vs £6.70) and 18 times greater than that for daytime frequency (willingness to pay £25.30 vs £1.40).…”

Acceptability and perceived value of urodynamics from the patient perspective: A narrative review

“…The aim was to understand attitudes about the need for diagnostic insight and their expectations regarding the specialist's management approach. Most patients expressed an expectation that the urologist would perform diagnostic examinations (90%), provide an explanation of the cause of their symptoms (97%), find the underlying cause of their symptoms (83%), and collaborate with them to formulate a treatment plan (88%) 27 . The expectations about undergoing diagnostic tests to clarify the cause of their symptoms were ‐ at this initial stage – much higher than expectations related to management and outcome.…”