Treatment decision-making among men with lower urinary tract symptoms: A qualitative study of men's experiences with recommendations for patient-centred practice

Selman, Lucy E.; Clement, Clare; Ochieng, Cynthia A.; Lewis, Amanda L.; Chapple, Christopher; Abrams, Paul; Drake, Marcus J.; Horwood, Jeremy

Abstract

Aims: To inform and guide patient-centred care for men with lower urinary tract symptoms (LUTS), by providing in-depth qualitative evidence regarding men's perspectives on treatment decision-making for LUTS. Methods: An interview study of men recruited from 26 English urology departments. Purposive sampling captured surgical/nonsurgical treatment decisions, and diversity in demographics and symptom burden, in men who had urodynamics and those who did not. After diagnostic assessments, men were interviewed either pre-treatment or after LUTS surgery. Thematic analysis was conducted. Participants’ descriptions of how LUTS treatment decisions were made were categorised as patient-led, doctor-led, or shared. Results: A total of 41 men participated (25 pre-treatment, 16 post-surgery), ages 52–89. Twenty out of 41 described the treatment decision as shared with their consultant, 14 as doctor-led, and seven as patient-led. There was no obvious association between treatment decision-making style and patients’ satisfaction with either clinicians’ role in their decision or their treatment decision. Incomplete or rushed discussions and misperceptions of LUTS and its treatment were reported, indicating a risk of suboptimal decision-making support by clinicians. As well as clinician opinion, men's treatment decision-making was influenced by the results of urological assessments, comparing current symptoms with possible side-effects of surgery, and others’ experiences and opinions. Conclusions: Men with LUTS report and prefer different kinds of decision-making support from their clinicians, who must tailor their input to patients’ preferences and needs. Patients’ treatment decision-making involves multiple factors and can be challenging, and areas of inadequate clinician support were identified. Recommendations for patient-centred consultations about LUTS treatment are presented.

• Journal Article Type: Article
• Acceptance Date: Sep 26, 2020
• Online Publication Date: Oct 14, 2020
• Publication Date: Jan 1, 2021
• Deposit Date: Jun 26, 2024
• Publicly Available Date: Jun 27, 2024
• Journal: Neurourology and Urodynamics
• Print ISSN: 0733-2467
• Electronic ISSN: 1520-6777
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Issue: 1
• Pages: 201-210
• DOI: https://doi.org/10.1002/nau.24533
• Public URL: https://uwe-repository.worktribe.com/output/12084643