MP5-17 RELATIONSHIP BETWEEN PATIENT EXPECTATIONS, FUNCTIONAL OUTCOMES, AND PATIENT SATISFACTION FOLLOWING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-17 RELATIONSHIP BETWEEN PATIENT EXPECTATIONS, FUNCTIONAL OUTCOMES, AND PATIENT SATISFACTION FOLLOWING RADICAL PROSTATECTOMY Michael Fenstermaker and Herbert Lepor Michael FenstermakerMichael Fenstermaker More articles by this author and Herbert LeporHerbert Lepor More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.244AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been postulated that accurate outcomes expectations are important contributors to patient satisfaction following radical prostatectomy (RP). We explore the relationship between patient expectations, functional outcomes, and patient satisfaction following open RP. METHODS Between January 2000 and March 2009, 1425 men undergoing open RP by a single surgeon enrolled in an IRB-approved prospective longitudinal outcomes study. Baseline and post-treatment functional outcomes were captured prospectively through 2013 using the UCLA Prostate Cancer Index. Differences between baseline function and the most recent reported functional outcome assessment were calculated. A total of 897 (62.9%) of these men responded to a survey in 2013 capturing the level of patient satisfaction with RP outcome and whether expectations regarding functional outcomes were accurate. Multivariable logistic regression models were fit to identify the association between patient expectations, change in functional outcomes, and satisfaction. RESULTS Overall, 87.9% of men were satisfied with their treatment outcomes following RP, and 81.2% and 52.9% responded that their expectations were moderately to extremely accurate for the urinary and sexual functional outcomes, respectively. The relationship between mean change in functional scores vs. patient satisfaction and expectations of functional outcomes vs. patient satisfaction are shown in Table 1. In a multivariate analysis, both lesser changes in functional scores and accuracy of patient expectations were independent predictors of patient satisfaction (Table 2). CONCLUSIONS Both changes in functional status and accurate patient expectations are important predictors of long-term satisfaction following open RP. Evidence-based preoperative counseling and expectations management are critical to ensure long-term patient satisfaction following RP. Satisfaction with Treatment Outcome by Functional Change and Accuracy of Outcome Expectations Total Cohort (n=897) Satisfied with Outcome (n=788) Unsatisfied with Outcome (n=109) p-valuea,b Change in Sexual Function, Median (IQR) -33 (-54.2, -16.7) -33 (-55.2, -12.5) -50 (-62.5, -31.7) <0.0001a Change in Urinary Function, Median (IQR) -11 (-27.7, 0) -11 (-27.7, 0) -27.7 (-61, -11) <0.0001a Expectations accurate for sexual function, n (%) Not at all 185 (20.6) 138 (18.0) 47 (44.3) <0.0001b Slightly 226 (25.2) 200 (26.0) 26 (24.5) Moderately 317 (35.3) 295 (38.4) 22 (20.8) Extremely 146 (16.3) 135 (17.6) 11 (10.3) Expectations accurate for urinary function, n (%) Not at all 50 (5.6) 24 (3.1) 26 (24.3) <0.0001b Slightly 113 (12.5) 88 (11.4) 25 (23.4) Moderately 344 (38.4) 308 (39.8) 34 (31.8) Extremely 375 (41.8) 353 (45.7) 22 (20.6) a: Mann-Whitney U Test, b: Chi-square Test Table 2. Predictors of treatment outcome satisfaction Model 1: Urinary Function Model 2: Sexual Function Change in Function OR (95% CI) OR (95% CI) Above Median 1.00 1.00 Below Median 2.00 (1.10-3.63) 2.32 (1.38-3.93) Expectations Met Not at all 1.00 1.00 Slightly 4.41 (1.86-10.43) 2.69 (1.44-5.04) Moderately 9.91 (4.52-21.73) 3.76 (2.01-7.06) Extremely 15.7 (6.61-37.42) 5.47 (2.26-13.28) Both models control for age, race, marital status, follow-up time, Gleason score, D Amico Risk, subsequent hormonal treatment, and reported importance of functional income © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e51-e52 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Fenstermaker More articles by this author Herbert Lepor More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...