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

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

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

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: Interview study of men recruited from 26 English urology departments. Purposive sampling captured, surgical/non-surgical 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: 41 men participated (25 pre-treatment, 16 post-surgery), ages 52-89. 20/41 described the treatment decision as shared with their consultant, 14 as doctor-led, and 7 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.
Original languageEnglish
Number of pages10
JournalNeurourology and Urodynamics
Early online date14 Oct 2020
Publication statusE-pub ahead of print - 14 Oct 2020

Structured keywords

  • UPSTREAM

Keywords

  • Decision Making
  • Lower Urinary Tract Symptoms
  • Patient-Centered Care
  • Patient Preference
  • Qualitative Research
  • Transurethral Resection of Prostate
  • Urodynamics
  • Urologic Surgical Procedures, Male

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