The effectiveness of “prompt sheet” in initiating a discussion of sexual dysfunction among male patients with diabetes in a primary care setting: an open-label control trial

Abstract

Background: Erectile dysfunction (ED) affects millions of men worldwide yet many are undiagnosed and untreated. Both doctors and men may have a miscommunication that ED is taboo to be brought up in the consultation. This study determined the effectiveness of prompt sheet in initiating a discussion of sexual dysfunction in a primary care setting. Methods: This was an open label control trial done at two government primary care clinics, one as a control and the other, an intervention group. All doctors in the participating clinics were given education on diagnosis and management of ED. Participants who came for their diabetes mellitus follow-up were approached. Those who consented to the study had their sociodemographic data recorded and erectile function evaluated using International Index of Erectile Function (IIEF-5). The patients in the intervention group (n = 69) received a prompt sheet allowing participants to indicate their decision, prior to consultation, of whether to discuss about erectile dysfunction. The prompt sheet was presented to their treating doctors during consultation. The control group (n = 65) received usual care. All participants would provide a written feedback whether there was any discussion about erectile dysfunction after the consultation. Results: A total of 134 participants completed the study. Ethnic distributions in intervention group differed significantly from the control group with 46.4% Chinese, 44.9% Malay, 7.2% Indian and 53.8% Chinese, 15.4% Malay, 29.2% Indian respectively. Other baseline characteristic of both groups (age, body weight, education level, employment, smoking, marital status, duration of diabetes and prevalence of ED) were similar. The prevalence of ED in both groups was about 80%. In the intervention group, only 59% of participants opted to discuss their sexual problems and among them, 80.5% of them had it discussed during the consultation. Thus, in the intervention group, 47.8% of total participants discussed about erectile dysfunction, compared to 4.6% in the control group (Odds Ratio (OR) 18.4, 95% Confidence Interval (CI): 5.4–66.2, p < 0.001). Sub-analysis did not reveal any relationship between either ethnicity or severity of ED and participant’s option to discuss ED. Conclusions: Prompt sheet is a simple and inexpensive tool to cue a discussion of erectile dysfunction during consultation. More importantly, prompt sheet provides patients an opportunity to indicate their interest of discussing ED to bridge the gap of miscommunication between men and doctors.