Patient preference elicitation instrument, OABCare, to facilitate shared decision‐making in the care of overactive bladder

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.

Section: Patient Preferences In Oab Treatment Decisionsmentioning

confidence: 97%

Section: Oab Decision Aidsmentioning

confidence: 99%

Section: Oab Decision Aidsmentioning

confidence: 99%

Section: Patient Preferences In Oab Treatment Decisionsmentioning

confidence: 99%

Section: Patient Preferences In Oab Treatment Decisionsmentioning

confidence: 99%

See 3 more Smart Citations

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

Paudel

Lane

2022

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

Kapur

Harandi

Cohen

et al. 2022

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.

Patient and physician decision‐making dynamics in overactive bladder care: A mixed methods study

Sitto,

Brodsky,

Wittmann

et al. 2024

AimsOveractive bladder management includes multiple therapeutic options with comparable efficacy but a range of administration modalities and side effects, creating an ideal setting for shared decision‐making. This study investigates patient and physician health beliefs surrounding decision‐making and expectations for overactive bladder with the aim of better understanding and ultimately improving decision‐making in overactive bladder care.MethodsPatient and physician participants completed a questionnaire followed by a semi‐structured interview to assess health beliefs surrounding decision making and expectations for overactive bladder treatment. The semi‐structured interview guide, developed in an iterative fashion by the authors, probed qualities of overactive bladder therapies patients and physicians valued, their process of treatment selection, and their experiences with therapies.ResultsPatients (n = 20) frequently cited treatment invasiveness, efficacy, and safety as the most important qualities that influenced their decision when selecting overactive bladder therapy. Physicians (n = 12) frequently cited safety/contraindications, convenience, cost/insurance, and patient preference as the most important qualities. In our integration analysis, we identified four key themes associated with decision making in overactive bladder care: frustration with inaccessibility of overactive bladder treatments, discordant perception of patient education, diverging acceptability of expected outcomes, and lack of insight into other parties' decisional priorities and control preferences.ConclusionsWhile both patients and physicians desire to engage in a shared decision‐making process when selecting therapies for overactive bladder, this process is challenged by significant divergence between patient and physician viewpoint across key domains.