Shared Decision-Making (SDM) for Female SUI: Current Practice in Three Western Countries

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Abstract
Introduction: Different decision-making styles can be used to provide counselling for the multiple reasonable treatment options for patients with stress urinary incontinence (SUI). Shared decision-making (SDM) is currently advocated as the preferred style for preference sensitive decisions, as SDM takes patient preferences into account. This study aimed to map the current decision-making process for SUI in three Western countries. Methods: We included 124 patients and 18 physicians in a multicentre, prospective study in five hospitals in Canada, the United Kingdom and the Netherlands. We used patient and physician versions of the Control Preference Scale (CPS) questionnaires and examined audio-recordings of consultations with the OPTION-5 instrument to assess the degree of SDM. Results: Most patients (63%) perceived the decision-making as informative, some (29%) as shared and only a few (8%) as paternalistic. Dutch patients more often perceived the decision-making as informative than UK or Canadian patients. Patients’ preferred and perceived decision-making styles matched in 70% of consultations. Patients’ and physicians’ perceptions of decision-making were the same in 60% of consultations, but their perceptions of SDM use did not match. This also did not match the OPTION-5 scores reflecting the use of SDM. Almost all patients were satisfied with the decision-making they perceived. Conclusion: Most patients and physicians prefer and perceive the current decision-making process as informative decision-making. However, patients and physicians have different perceptions of their mutual consultation. This highlights the imprecise concept of SDM for both patients and physicians.

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