Supporting the Choice for Conservative and Surgical Treatment in Female Stress Urinary Incontinence: Development and Evaluation of a Patient Decision Aid

Author:

Gerritse Maria B. E.12ORCID,de Vries Marieke3,The Regina4,Heesakkers John P. F. A.5ORCID,Lagro‐Janssen Antoine L. M.6,Huub van der Vaart C.7,Kluivers Kirsten B.1ORCID

Affiliation:

1. Department of Gynecology Radboud University Medical Center Nijmegen The Netherlands

2. Department of Obstetrics and Gynecology Gelderse Vallei Hospital Ede The Netherlands

3. Department of Data Science Radboud University Nijmegen The Netherlands

4. ZorgKeuzeLab Delft The Netherlands

5. Department of Urology Maastricht University Medical Center Maastricht The Netherlands

6. Department of Primary and Community Care, Research Institute for Medical Innovation Radboud University Medical Center Nijmegen The Netherlands

7. Department of Gynecology University Medical Center Utrecht Utrecht The Netherlands

Abstract

ABSTRACTIntroductionMaking a treatment decision for female stress urinary incontinence (SUI) can be challenging for patients and healthcare providers. Dutch guidelines advise to counsel both pelvic floor muscle therapy and midurethral sling surgery as primary treatment options in uncomplicated moderate to severe cases. The use of a patient decision aid (PDA) can support decision‐making, reduce decisional conflict and decisional regret, and increase knowledge. The aim of this study was to develop and evaluate an online PDA for females (SUI).MethodsThis mixed‐methods study was performed in consecutive stages by a multidisciplinary working group. PDA design was based on the International Patient Decision Aids Standards (IPDAS) and on outcomes of needs assessments amongst patients and healthcare providers. Content was based on Dutch guidelines, targeted literature searches and patient information from the Dutch scientific society for gynecology. The concept version was evaluated by patients, patients' advocates, and healthcare providers.ResultsUsing the nominal group technique, the working group established the design and format of the PDA. Fifty‐six out of 58 applicable items of the IPDAS were met. The PDA contains information on the condition, advice on lifestyle adaptations, and describes surgical and nonsurgical treatment options. The option grid contains comparisons of the primary treatment options. Furthermore, value clarification exercises and narratives were included. Acceptability and usability evaluation of the concept version was performed by 15 healthcare providers, three patients, and two patients' advocates. Comments were processed in the working group, resulting in the final version of the PDA, which was supported by all assessors.ConclusionOur multidisciplinary working group developed an online PDA for women with moderate to severe SUI including conservative and surgical treatment options, based on IPDAS criteria, guidelines, scientific evidence, and needs assessments from patients and healthcare providers. This PDA is supported by patients, healthcare providers, scientific societies, and the Dutch patients' association. The next step is to evaluate and implement this PDA in daily practice.Trial RegistrationID 2014‐308.

Funder

ZonMw

Publisher

Wiley

Reference26 articles.

1. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction

2. Lifetime Risk of Stress Urinary Incontinence or Pelvic Organ Prolapse Surgery

3. Prevalence and trends in urinary incontinence among women in the United States, 2005–2018

4. Pelvic Floor Muscle Training Versus No Treatment, or Inactive Control Treatments, for Urinary Incontinence in Women;Dumoulin C.;Cochrane Database of Systematic Reviews,2018

5. Mid‐Urethral Sling Operations for Stress Urinary Incontinence in Women;Ford A. A.;Cochrane Database of Systematic Reviews,2017

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