To investigate which treatment attributes matter to patients with stress urinary incontinence (SUI), why and how they matter, and the context in which patients consider treatment attributes. Nearly a quarter of older men have decisional regret following SUI treatment. Knowledge of what matters to patients when making SUI treatment decisions is necessary to improve goal-concordant care.
We conducted semi-structured interviews with 36 men ≥ 65 years of age with SUI. Semi-structured interviews were conducted by telephone and transcribed. Four researchers (LH, NS, EA, CB) coded the transcripts using both deductive and inductive codes to identify and describe treatment attributes.
We identified 5 patient-derived treatment attributes of interest among older men with SUI who have faced treatment decisions: 1) dryness, 2) simplicity, 3) potential need for future intervention, 4) treatment regret/satisfaction, and 5) surgical avoidance. These themes reliably emerged in our patient-centered interviews from within various contexts, including prior negative healthcare experiences, the impact of incontinence on daily and quality of life, and the mental health burden of incontinence, among others.
Men with SUI weigh a variety of treatment attributes in addition to dryness, a traditional clinical endpoint, and do so within the context of their individual experience. These additional attributes, such as simplicity, may run counter to the goal of dryness. This suggests that traditional clinical endpoints alone are not adequate for counseling patients. Contextualized patient-identified treatment attributes should be used to create decision support materials to promote goal-concordant SUI treatment.
Urology. 2023 Apr 17 [Epub ahead of print]
Lindsay A Hampson, Nathan Shaw, Benjamin N Breyer, Louise C Walter, Rebecca L Sudore, Matthew R Cooperberg, Caitlin Baussan, Kathryn Quanstrom, I Elaine Allen, Dan Dohan
Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California; Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California. Electronic address: ., Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California., Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California., Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California., Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California; Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California., University of Pittsburg School of Health and Rehabilitation Sciences, Pittsburg, Pennsylvania., Department of Internal Medicine, Trinity Health Livonia Hospital., Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California., Institute for Health Policy Studies, Department of Medicine, University of California San Francisco, San Francisco, CA.