Delivering patient‐centered care through shared decision making in overactive bladder

Abstract

Introduction Men and women living with overactive bladder (OAB) face many treatment decisions as they progress through the treatment pathway. Decisions to pursue specific therapies are highly preference sensitive and ideal for shared decision making (SDM). The aim of this narrative review is to provide urologists with a practical summary of methods to elicit preferences and facilitate SDM to promote patient‐centered care for OAB. Methods We explore OAB as a preference sensitive condition through a review of treatment outcomes and present available data on prediction tools, patient preferences, and decision aids. We propose a paradigm for applying Everyday SDM to OAB care. Results Clinical outcome data points to equipoise (balanced outcomes) between options for first‐, second‐, and third‐line OAB therapies, making OAB preference sensitive and appropriate for SDM. Methods to personalize care through individualized outcome prediction calculators and tools to elicit patient preferences are emerging. While patient information about OAB is readily available, we identified few OAB decision aids that facilitate patient preference elicitation and SDM. Conclusions OAB is a preference sensitive condition, where treatment is largely based on the patient's preferences and values. SDM is an ideal approach to supporting patients through these treatment decisions. We propose the application of Everyday SDM, a personalized, clinically efficient methodology as a method to support patient‐centered OAB care.

Patient and physician decision‐making dynamics in overactive bladder care: A mixed methods study

“…The current treatment paradigm includes a stepwise trial of first‐line behavioral changes, second‐line pharmacologic therapies, and third‐line (advanced) neuromodulation or chemodenervation. This approach to OAB care can be inefficient and frustrating to patients and physicians, and a tailored approach to advanced OAB care is needed 3,4 . Attrition from pharmacotherapy is well documented, with over half of patients discontinuing medications within 5 months 5 .…”

An analysis of factors that influence patient preference of third‐line therapy for overactive bladder

“…8 Though choice of OAB therapy is largely guided by patient preference, there is limited information on which features of each third-line therapy patients find favorable and unfavorable, and how these preferences guide choice of which third-line therapy is pursued. 9 Physical, social, and emotional factors impact how patients perceive each third-line therapy and the features of each therapy that they may find subjectively beneficial versus harmful. While medication frustration and potential for improved OAB-related quality of life are incentivizing factors for desire to proceed to third-line therapy, perception of invasive treatments and concern regarding efficacy and adverse effects may affect patients' actual progression to such interventions.…”

“…Among OAB patients, the factors deemed most impactful deciding on a treatment include caregiver burden, impaired bladder function, impact on social interactions, side effects, and the use of pads 8 . Though choice of OAB therapy is largely guided by patient preference, there is limited information on which features of each third‐line therapy patients find favorable and unfavorable, and how these preferences guide choice of which third‐line therapy is pursued 9 . Physical, social, and emotional factors impact how patients perceive each third‐line therapy and the features of each therapy that they may find subjectively beneficial versus harmful.…”

Management of complex OAB patients: A call to action

“…8 We provide a pragmatic approach to shared decision making and the tools to accomplish this in the review by Paudel and Lane. 9 The most clinically complex patients are those with overlapping lower urinary tract conditions, hence these are discussed thoroughly in Shapiro et al, 10 where the intersection of OAB and prostatic enlargement are explored. Bladder pain and OAB also have significant overlap and treatment approaches to these coexisting conditions are elaborated in the review by Dobberfuhl.…”

“…In this Special Issue, we present a collection of review articles that thoughtfully span the most complex issues faced by both patient and practitioner as it relates to diagnosis, shared decision making, therapy, and long‐term management with proposed solutions by experts in the field for some of the most challenging OAB populations 8 . We provide a pragmatic approach to shared decision making and the tools to accomplish this in the review by Paudel and Lane 9 . The most clinically complex patients are those with overlapping lower urinary tract conditions, hence these are discussed thoroughly in Shapiro et al, 10 where the intersection of OAB and prostatic enlargement are explored.…”