Abstract
Introduction and hypothesisFollowing the design, face validation and publication of a novel PDA for women considering SUI surgery, the main objective of the study is to evaluate the usefulness of SUI-PDA© by using a validated tool to obtain patient feedback.MethodsFrom July 2018 to March 2019, the PDA, already incorporated into the patient care pathway, was objectively evaluated using the Decisional Conflict Scale (DCS) to determine patients’ views. Patients recorded their values and reasons for requests and declines of treatment. The total DCS score, scores from each DCS subgroup and individual patient responses were calculated and analysed.ResultsThe mean age of the first 20 patients to complete the DCS was 54 years, the mean BMI was 30.1 and the median parity was 3. The average total DCS score was only 9.29 out of 100 (range 0–29.69) suggesting that the PDA was quite useful for patients considering SUI surgery. Overall, the PDA had largely favourable responses across all five DCS subgroups. The ‘informed’ subgroup had the best score (6.67) while the ‘uncertainty’ subgroup had the least favourable score (14.58). Despite the procedure pause, the mesh tape option remained on the PDA; however, no patient had chosen this option, with a large proportion citing ‘safety’ issues as the main reason. Bulking agent injections were the most popular choice (40.0%) and the most commonly performed procedures (50.0%) mainly because of quicker ‘recovery’. The second most popular participant choice was colposuspension (35.0%) followed by autologous fascial sling (25.0%), with women citing ‘efficacy’ as the main reason behind their choice.ConclusionSUI-PDA© was reported by patients and clinicians to be useful with clinical decision-making for SUI surgery. Further validation in a larger patient group is underway.
Highlights
SUI is the loss of urine when coughing, laughing, sneezing or exercising
This study reports the development and validation of SUI-patient decision aids (PDAs) as well as the initial evaluation of its usefulness in clinical practice for women considering SUI surgery
The ‘What Matters To Me’ component (Fig. 2) clarifies patients’ own values and is comprised of 13 aspects of clinical care that may matter to women considering SUI surgery, e.g. ‘Avoid major abdominal surgery’ and ‘Quicker recovery...’
Summary
SUI is the loss of urine when coughing, laughing, sneezing or exercising. It is a common and distressing condition, with negative impact on quality of life. The prevalence varies from 20 to 50% and is associated with age and parity [1]. E.g. pelvic floor muscle training, is not successful, the most successful surgical procedures are midurethral mesh tape, colposuspension, autologous fascial sling and urethral bulking agent injections. Women have a 10% lifetime risk of requiring continence surgery [1]. Between April 2008 to March 2017, procedure data from the UK NHS confirmed that 100,516 patients had a midurethral tape procedure, while only 1195 patients had a nontape SUI procedure [2].
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