Shared Decision-making in Urologic Practice: Results From the 2019 AUA Census

Lane, Giulia I.; Ellimoottil, Chad; Wallner, Lauren P.; Meeks, William; Mbassa, Rachel; Clemens, J. Quentin

doi:10.1016/j.urology.2020.06.078

Cited by 13 publications

(18 citation statements)

References 13 publications

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“…24 A recent look at SDM in urology practice was carried out using the 2019 American Urological Association Census Shared Decision Making module. 25 Of 2,219 respondents, 77% reported regular use of SDM in at least 1 preference-sensitive scenario. SDM can be buoyed by decision support tools, which have been shown in rigorous research to improve patients' knowledge and accuracy of risk perceptions, increase the likelihood of patients making care choices that are congruent with their values, decrease decisional conflict, have a positive effect on patient-clinician communication and improve satisfaction with decisions and the decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions

et al. 2022

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Purpose: When seeking treatment for male stress urinary incontinence (mSUI), patients are faced with weighing complex risks and benefits in making treatment decisions within their individual context. We sought to quantify the frequency of decisional regret among this population and to determine factors associated with regret. Materials and Methods: A cohort of 130 males aged !65 years seen for initial mSUI consultation at the University of California, San Francisco Medical Center and the San Francisco Veterans Affairs Medical Center between June 2015 and March 2020 was developed. Using retrospective chart review and telephone interviews, we ascertained decisional regret as well as other patient-, disease-and treatment-related characteristics. Decisional regret was analyzed by treatment type and patient-, disease-and treatment-related factors. Multivariable logistic regression models were built to examine the factors most associated with decisional regret. Results: Among the entire cohort, 22% reported moderate to severe decisional regret. Regret was highest among those electing conservative management, with 34.7% having decisional regret (vs with surgery: 8.3% sling, 8.2% sphincter; p <0.001). In multivariable analysis, depression, lower rating of shared decision making and higher current incontinence scores were significantly associated with decisional regret. Conclusions: Recognition of depression, improved efforts at shared decision making and more individualized treatment counseling have the potential to improve patient satisfaction with treatment choice. In addition, given high levels of regret among those electing conservative treatment, we may be underutilizing mSUI surgery in this population.

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Section: Discussionmentioning

confidence: 99%

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions

et al. 2022

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“…This parallels the urological provider finding that the proportion of urologists who regularly ask patients' preferences is notably lower than the rate of discussing treatment options and risks and benefits. 16 The literature describing a correlation between patient reported SDM and patients' rating of their surgeon is less clear. Our prior work based on this patient sample found that global surgeon rating correlates most with postoperative communication and has low correlation with preoperative preparation.…”

Section: Discussionmentioning

confidence: 99%

Patient Reported Shared Decision Making in Urology from the Surgical Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

et al. 2021

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Introduction: Shared decision making balances the best available evidence with patients' preferences and values in order to make a medical decision. The use of shared decision making and its link to clinically meaningful outcomes are not well described in urology. We report the rates of shared decision making among patients undergoing urological surgery, and explore the relationship between shared decision making and patient reported surgeon ranking.Methods: This study uses Consumer Assessment of Healthcare Provider and Systems Surgical Care Survey data from patients undergoing urological surgery between 2011 and 2013. A shared decision making composite score was created from the sum of 3 survey items. We fit an ordinal logistic regression model to evaluate factors that influence patients' overall shared decision making score. In a separate model, we evaluated how shared decision making and use of decision aid impact patients' ranking of surgeons.Results: In this sample, 430 (33.8%) surveys were returned. Of respondents, 71% scored maximum points on the shared decision making composite score and 59% reported that their surgeon used a decision aid. Discussing alternative treatment options was the most often omitted step in shared decision making. Patients who report use of a decision aid had nearly double the odds of selfreported shared decision making (OR 1.84, 95% CI 1.10e3.06, p¼0.02). Shared decision making or decision aid use was not associated with patient reported surgeon ranking. Conclusions:The majority of patients reported shared decision making and decision aid use during preoperative counseling. Patients reporting decision aid use had nearly double the odds of reporting shared decision making. There was no correlation between either shared decision making or decision aid use and patients' ranking of their surgeon.

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“…Challenges to implementation and use of SDM have been well documented within urology. 4,24 Recent data point to urologists as key facilitators of SDM and decision aid use and clinician engagement may be a way to overcome this barrier. 50 We present SDM for OAB within the context of the tier-based treatment framework recommended by the American Urological Association guidelines and focus our review on therapies included in the guidelines.…”

Section: Limitationsmentioning

confidence: 99%

“…Our proposed paradigm of patient‐centered care in OAB using Everyday SDM is not without limitations. Challenges to implementation and use of SDM have been well documented within urology 4,24 . Recent data point to urologists as key facilitators of SDM and decision aid use and clinician engagement may be a way to overcome this barrier 50 .…”

Section: Limitationsmentioning

confidence: 99%

“…Despite the benefits, urologists vary in their use of SDM steps, with 87% reporting regularly discussing treatment options for urinary incontinence but only 66% eliciting patient preferences and 54% regularly using decision aids. 4 An alternative and clinically practical approach called Everyday Shared Decision Making has been proposed to personalize care in low-stakes medical decisions. 5 Everyday SDM differs from traditional SDM by providing focused recommendations based on individualized estimates of potential benefit and harm from treatment and then inviting conversation about the recommendation and its alternatives.…”

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

Paudel

Lane

2022

Neurourology and Urodynamics

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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.

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Shared Decision-making in Urologic Practice: Results From the 2019 AUA Census

Cited by 13 publications

References 13 publications

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions

Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions

Patient Reported Shared Decision Making in Urology from the Surgical Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

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

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