Nienke J. E. Osse

Introduction: Treatment decisions for stress urinary incontinence (SUI) are preference sensitive, because the disease is non-lethal and there are multiple reasonable treatment options. However, little is known about patients’ and physicians’ preferred decision-making styles for SUI. To aid physicians in their counselling and decision-making in consultations for SUI, we studied patients’ and physicians’ preferred and perceived decision-making in medical specialist consultations for SUI. Methods: This mixed-methods study combined the validated control preference scale (CPS) and the CPS perception version, and semi-structured, in-depth interviews with both patients and physicians. This study took place in Canada, the United Kingdom and the Netherlands. Sixteen physicians from all three countries and seventeen women from the Netherlands and Canada were interviewed. Results: All women expressed a preference for being involved in the decision-making process, either by informative or shared decision-making (SDM) in the CPS, because they valued the autonomy to make their own choice regarding treatment for SUI and appreciated receiving information and advice from their doctor. Physicians also preferred an involved patient, but used medical expertise to steer towards their preferred treatment option. Physicians found SDM difficult to understand, expressing different interpretations. Conclusions: SDM is not a precise concept either for patients or physicians, with multiple interpretations. All patients with SUI want to be involved in the decision-making process, either by informative or by shared decision-making. Physicians both express the desire to involve patients in their decision making, but conversely to steer patients towards the decision that they feel suits them best.

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.

Introduction and Hypothesis: Treatment options for female stress urinary incontinence (SUI) are often offered in a stepped-care approach. However, the shift towards patient-centred care and shared decision making (SDM) has prompted an increased interest in patients’ perceptions of treatment decision making. This scoping review maps the available qualitative research on women’s perceptions of the treatment decision-making process for SUI and identifies knowledge gaps. Methods: This scoping review was performed according to the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Three databases were searched using a systematic search strategy, without restriction in publication date or language. After thorough screening, 19 of the initial 3,473 publications were included. Results: Four themes were identified; pre-existing experiences and notions that women bring to the consultations (things women consider before their consultation); treatment and patient characteristics (treatment aspects and personal values patients deem important); aspects of the consulting health care professional and facilities (availability of treatment options and counselling styles of physicians); ways of reaching a decision (three different ways that women used to make their decision. There were gaps in the literature on aspects affecting women’s treatment preferences, their preferred decision-making style and how they want to be involved in this decision-making process. Conclusions: This scoping review provides a global overview of women’s perceptions on and preferences for treatment for SUI, and highlights a lack of knowledge on women’s ideas of the treatment decision process. To provide clinicians with better guidance for their counselling and decision-making approaches, studies on women’s perceptions of the decision-making process and the different decision-making styles are needed.

Objectives: Midurethral slings are considered the gold standard for the surgical treatment of stress urinary incontinence (SUI), with an efficacy up to 80%. Another therapeutic option is the use of bulking agents, which create an artificial mass in the urethral submucosa, with an efficacy varying from 64% to 74%. Although bulking agents have a lower risk of complications than midurethral sling surgery, they are mainly used in case a midurethral sling is not an option or if midurethral sling surgery failed to cure stress urinary incontinence. In this study, we offer all patients with SUI in secondary care a choice between a single-incision midurethral sling procedure and treatment with a bulking agent. We want to examine patient preference and patient satisfaction for both procedures. We expect that offering both interventions in combination with standardized counselling will result in high patient satisfaction. Design: In this non-randomized controlled trial, 266 patients will be objectively counselled for both interventions, after which all patients will choose between single-incision midurethral slings and polyacrylamide hydrogel (PAHG), followed by the standard care procedure for women with SUI. Participants/Materials, Setting, Methods: From January 1, 2021, onward, all consecutive adult patients (between 18 and 80 years of age) attending the outpatient gynaecology department with objectively confirmed, moderate to severe SUI will be eligible for enrolment in this non-randomized study. The primary outcome is patient satisfaction at 1 year, measured by the Patient Global Impression of Improvement; secondary outcomes are patient satisfaction at 3 months, objective and subjective cure at 3 months and 1 year, adverse events, post-operative pain, and cost-effectiveness. Differences in outcome measures will be assessed through logistic and linear regression analyses, both unadjusted and adjusted with covariate adjustment using the propensity score. Results: No results are available yet. Limitations: The major disadvantage of this study design is the potential confounding bias. We intend to eliminate this bias by applying propensity scoring. Conclusion: By designing a non-randomized patient preference trial, we not only expect to demonstrate high patient satisfaction with both interventions but also provide insight into the possible role of PAHG-injections in the treatment of female SUI as a first-choice non-conservative treatment.