Utility of patient decision aids (PDA) in stress urinary incontinence surgery

Abstract

Introduction and hypothesis Patient decision aids (PDAs) facilitate shared decision making allowing patients to make decisions about their healthcare that take into account their personal values and preferences. The aim of this study was to establish whether a PDA used in women requiring stress incontinence surgery is helpful to women when making choices about the treatments they choose by using a Decision Conflict Scale (DCS). Methods Forty-five consecutive women were identified as having stress urinary incontinence and had completed all conservative treatments. All patients included in the study had stress urinary incontinence confirmed on urodynamic testing and were given the PDA at the point where they needed to make a decision about surgery. Following completion of the PDA, patients were given a DCS to complete which measures personal perceptions of uncertainty when making a decision about treatment. Results Forty-three out of 45 (95.5%) patients scored 4/4 for the DCS indicating they were sure of their decision. Two patients (4.5%) scored 3/4 and were therefore unsure of their choice. No patient scored < 3 on the DCS. The choice of procedures varied in all the ages and two women opted to have no treatment. Conclusions The use of a PDA in the surgical treatment of stress urinary incontinence reduces decision conflict and ensures patients are sure of their decision, understand the information provided as well as the risk benefit ratio of the various options and feel they have adequate support and advice to make a choice. Electronic supplementary material The online version of this article (10.1007/s00192-019-03982-1) contains supplementary material, which is available to authorized users.

Response to letter to the editor regarding “Utility of patient decision aids (PDA) in stress urinary incontinence surgery”

“…We thank Ong et al for their interest in our article "Utility of patient decision aids (PDA) in stress urinary incontinence surgery" [1]. Regarding the PDA that was used, we have declared in the methodology that neither the development nor the content was the subject of this paper.…”

“Voice your choice”: a study of women’s choice of surgery for primary stress urinary incontinence

“…It also treats bulking as a separate category of treatment. Other PDAs for SUI have been published [3,4]; however, these are based on expert opinion rather than a systematic meta-analysis of the evidence which NICE undertook. Furthermore, none of the PDAs were informed by how women chose an operation for SUI.…”

Factors influencing patient decision making in Urogynaecology: You are what you know

“…In fact, most women with pelvic floor disorders will accept surgical intervention and welcome comprehensive clinical assessment provided that they understand the underlying pathology and receive explanation of the available treatment modalities [6]. Patient decision aids (PDA) are a very useful tool in this context [9]. Given that the information on the internet and in blogs can be confusing and contradictory, PDAs like fact boxes may help all women with pelvic floor disorders whether they are baby boomers or younger women in their decision making process.…”

“…Given that the information on the internet and in blogs can be confusing and contradictory, PDAs like fact boxes may help all women with pelvic floor disorders whether they are baby boomers or younger women in their decision making process. Data on success rates and surgical factors like hospital stay, postoperative complications, pain relief, type of anesthesia and recovery period can easily be summarized to the patient [9]. Ideally, the data should be individualized and based on the care provider's records and experience.…”