Patient Perceptions Impact Progression to Third-Line Therapy for Treatment of Overactive Bladder

Objective Patients with overactive bladder (OAB) refractory to first‐ and second‐line therapy may pursue third‐line therapies, including intradetrusor onabotulinum toxin‐A (BTX), peripheral tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The factors that influence patient preference for each treatment modality have not yet been explored. This study sought to investigate the specific parameters that patients consider in choosing a third‐line therapy for OAB. Methods Patients refractory to first‐ and second‐line therapies for OAB were identified in our outpatient clinic and asked to watch an educational video providing information on the risks and benefits of each third‐line treatment option. They were then given a questionnaire to rank their preference of therapy and select reasons for why they found each therapy favorable and unfavorable. Patients under age 18 years, non‐English speakers, those with a developmental disability, and those with a diagnosis of neurogenic bladder were excluded. Results Of the 98 patients included in the study, 40 participants (40.8%) chose intradetrusor BTX injections, 34 (34.7%) chose PTNS, and 16 (16.3%) chose SNM as their first choice. Seven patients (7.1%) chose none of the offered therapies, and one patient (1.0%) chose all three therapies with equal preference. BTX was found most attractive for its long efficacy (47%); its least attractive feature was the potential need for self‐catheterization due to urinary retention (54%). PTNS was found most attractive for being a nonsurgical option (32%) and having no reported significant complications (39%); its least attractive feature was need for frequent office visits (61%). SNM was found most attractive for its potential for long‐term relief without frequent office visits (53%); its least attractive feature was need for an implanted device (33%). Patients opting for SNM had higher scores on Urinary Distress Inventory‐6 and Incontinence Impact Questionnaire‐7 questionnaires when compared to patients opting for BTX injections or PTNS (p < 0.05). 47.4% of patients eventually pursued a third‐line therapy. Of those, there was a 67.6% concordance rate between the therapy patients ranked first and the therapy they eventually underwent. Conclusions Patients with more severe OAB symptoms opt for more invasive and less time‐consuming therapy with the potential for long‐term relief, namely SNM. Despite thorough counseling, many patients do not progress to advanced OAB therapies. Understanding factors that influence patients' affinity toward a specific type of treatment can aid with individualized counseling on third‐line OAB therapies.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An analysis of factors that influence patient preference of third‐line therapy for overactive bladder

Kapur

Harandi

Cohen

et al. 2022

Delivering patient‐centered care through shared decision making in overactive bladder

Paudel

Lane

2022

Introduction Men and women living with overactive bladder (OAB) face many treatment decisions as they progress through the treatment pathway. Decisions to pursue specific therapies are highly preference sensitive and ideal for shared decision making (SDM). The aim of this narrative review is to provide urologists with a practical summary of methods to elicit preferences and facilitate SDM to promote patient‐centered care for OAB. Methods We explore OAB as a preference sensitive condition through a review of treatment outcomes and present available data on prediction tools, patient preferences, and decision aids. We propose a paradigm for applying Everyday SDM to OAB care. Results Clinical outcome data points to equipoise (balanced outcomes) between options for first‐, second‐, and third‐line OAB therapies, making OAB preference sensitive and appropriate for SDM. Methods to personalize care through individualized outcome prediction calculators and tools to elicit patient preferences are emerging. While patient information about OAB is readily available, we identified few OAB decision aids that facilitate patient preference elicitation and SDM. Conclusions OAB is a preference sensitive condition, where treatment is largely based on the patient's preferences and values. SDM is an ideal approach to supporting patients through these treatment decisions. We propose the application of Everyday SDM, a personalized, clinically efficient methodology as a method to support patient‐centered OAB care.

Determining patient preferences in the treatment of medication‐refractory overactive bladder

Speed

Welk

Comiter

et al. 2022

Introduction Overactive bladder (OAB) is often suboptimally addressed by behavioral or pharmacological treatments. Less than 15% of patients choose to pursue advanced OAB therapy (sacral nerve stimulation [SNS], percutaneous tibial nerve stimulation [PTNS], and bladder onabotulinum toxin type‐A [BTX‐A]). We seek to better understand which factors are most important to patients when choosing a third‐line therapy. Methods/Materials We developed a conjoint analysis survey that included five attributes of the third‐line options for OAB (SNS, PTNS, and BTX‐A). We administered the survey to new patients with urinary incontinence at two institutions. A hierarchical Bayes random effects regression analysis was used to determine the relative importance of the attributes. A choice simulator was used to model which third‐line treatment options patients preferred. We followed patients to see if they pursued their predicted treatment. Results A total of 108 patients completed the study of whom 89% were women. There was representation from all age groups. The most important attributes of decision‐making were the frequency of future procedures, the risk of catheterization, and the need for a device. On market simulation, SNS was the preferred treatment option (47%), followed by PTNS (29%) and BTX‐A (14%). Only 10% of patients did not find any treatment option acceptable. Conclusions Frequent follow‐up, risk of catheterization, and the need for a device were the most important attributes when making a decision on third‐line OAB therapy. On market simulation, SNS is the preferred treatment for all age groups though the ultimate choice in third‐line therapy may be affected by external factors.