Determining patient preferences in the treatment of medication‐refractory overactive bladder

Abstract

Introduction Overactive bladder (OAB) is often suboptimally addressed by behavioral or pharmacological treatments. Less than 15% of patients choose to pursue advanced OAB therapy (sacral nerve stimulation [SNS], percutaneous tibial nerve stimulation [PTNS], and bladder onabotulinum toxin type‐A [BTX‐A]). We seek to better understand which factors are most important to patients when choosing a third‐line therapy. Methods/Materials We developed a conjoint analysis survey that included five attributes of the third‐line options for OAB (SNS, PTNS, and BTX‐A). We administered the survey to new patients with urinary incontinence at two institutions. A hierarchical Bayes random effects regression analysis was used to determine the relative importance of the attributes. A choice simulator was used to model which third‐line treatment options patients preferred. We followed patients to see if they pursued their predicted treatment. Results A total of 108 patients completed the study of whom 89% were women. There was representation from all age groups. The most important attributes of decision‐making were the frequency of future procedures, the risk of catheterization, and the need for a device. On market simulation, SNS was the preferred treatment option (47%), followed by PTNS (29%) and BTX‐A (14%). Only 10% of patients did not find any treatment option acceptable. Conclusions Frequent follow‐up, risk of catheterization, and the need for a device were the most important attributes when making a decision on third‐line OAB therapy. On market simulation, SNS is the preferred treatment for all age groups though the ultimate choice in third‐line therapy may be affected by external factors.

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

“…Patient and physician semi‐structured interview guides were developed, piloted, and refined based on prior literature and a conceptual model of SDM for OAB 3,10,11 . Patient interview analysis informed physician interview guide development.…”

“…Patient and physician semi-structured interview guides were developed, piloted, and refined based on prior literature and a conceptual model of SDM for OAB. 3,10,11 Patient interview analysis informed physician interview guide development. Interviews were conducted remotely using audio and video-conferencing software (Zoom) and were recorded and transcribed verbatim.…”

“…Surveys were developed and piloted in an iterative fashion based on a targeted literature review and a conceptual model of shared decision making (SDM) for OAB. 3,10,11 The patient survey queried demographics, onset of OAB symptoms, details regarding care-seeking, and treatments offered and tried for OAB. Analysis of patient interviews and surveys informed creation of the physician survey.…”

Evolving types of pudendal neuromodulation for lower urinary tract dysfunction

“…Overactive bladder (OAB), defined by the International Continence Society as ‘a syndrome characterized by urgency with or without urgency incontinence, usually with frequency and nocturia’, affects approximately 16.5% of adults [ 1 ]. It affects tens of millions of people worldwide, necessitating an economic burden through treatment costs [ 2 ].…”