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Wheeler JR, Tikkinen KAO, Guyatt G, Malde S. How Can We Understand Patients' Values, Preferences, and Expectations in Urology? Eur Urol Focus 2023; 9:719-722. [PMID: 37863738 DOI: 10.1016/j.euf.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
Understanding patients' values and preferences is essential for patient-centred care. Qualitative research provides a broader understanding from a patient perspective at different time points across the patient's life. Quantitative methods quantify specific preferences and answer specific questions that have been informed by qualitative work.
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Affiliation(s)
- Jessica R Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Husted M, Gray D, Golding SE, Hindley R. Reaching a Tipping Point: A Qualitative Exploration of Quality of Life and Treatment Decision-Making in People Living With Benign Prostatic Hyperplasia. QUALITATIVE HEALTH RESEARCH 2022; 32:1979-1992. [PMID: 36154347 PMCID: PMC9629511 DOI: 10.1177/10497323221129262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Benign prostatic hyperplasia (BPH) is a common condition amongst older men and is associated with lower urinary tract symptoms and erectile dysfunction; these symptoms can be burdensome and negatively affect quality of life. Various surgical and pharmaceutical treatment options exist but there is a paucity of qualitative research exploring men's decision-making when seeking BPH treatment. This study qualitatively explored men's experience of living with BPH and seeking treatment for BPH. Twenty men (aged 52-75) were recruited from outpatient urology clinics at a hospital trust in Southern England. Data were collected using semi-structured interviews (via video or telephone call) and were audio-recorded; transcripts were analysed using thematic analysis. Four themes were generated: 'Impacts are about more than just physical symptoms', 'The path towards treatment', 'The process of information gathering' and 'Navigating hopes, fears and uncertainty'. Results indicate most men appear to seek treatment for BPH following a gradual, and sometimes lengthy, period of deterioration in symptoms; for some men, however, treatment seeking follows an acute episode of sudden or severe symptoms. The decision to proceed with surgical or minimally invasive treatment options appears to be dependent on men reaching a tipping point; they no longer perceive their symptoms as tolerable and feel their ability to cope with symptoms is reduced. Men each bring their own set of concerns and preferences about side effects and risk-benefit profiles of different treatments. Clinicians need to be sensitive to these individual differences and incorporate them into shared decision-making for choosing between treatment options for BPH.
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Affiliation(s)
- Margaret Husted
- Department of Psychology, University of Winchester, Winchester, UK
| | - Debra Gray
- Department of Psychology, University of Winchester, Winchester, UK
| | - Sarah E. Golding
- Department of Psychology, University of Winchester, Winchester, UK
| | - Richard Hindley
- Department of Psychology, University of Winchester, Winchester, UK
- Urology Department, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
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Karim S, Craig BM, Vass C, Groothuis-Oudshoorn CGM. Current Practices for Accounting for Preference Heterogeneity in Health-Related Discrete Choice Experiments: A Systematic Review. PHARMACOECONOMICS 2022; 40:943-956. [PMID: 35960434 DOI: 10.1007/s40273-022-01178-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Accounting for preference heterogeneity is a growing analytical practice in health-related discrete choice experiments (DCEs). As heterogeneity may be examined from different stakeholder perspectives with different methods, identifying the breadth of these methodological approaches and understanding the differences are major steps to provide guidance on good research practices. OBJECTIVES Our objective was to systematically summarize current practices that account for preference heterogeneity based on the published DCEs related to healthcare. METHODS This systematic review is part of the project led by the Professional Society for Health Economics and Outcomes Research (ISPOR) health preference research special interest group. The systematic review conducted systematic searches on the PubMed, OVID, and Web of Science databases, as well as on two recently published reviews, to identify articles. The review included health-related DCE articles published between 1 January 2000 and 30 March 2020. All the included articles also presented evidence on preference heterogeneity analysis based on either explained or unexplained factors or both. RESULTS Overall, 342 of the 2202 (16%) articles met the inclusion/exclusion criteria for extraction. The trend showed that analyses of preference heterogeneity increased substantially after 2010 and that such analyses mainly examined heterogeneity due to observable or unobservable factors in individual characteristics. Heterogeneity through observable differences (i.e., explained heterogeneity) is identified among 131 (40%) of the 342 articles and included one or more interactions between an attribute variable and an observable characteristic of the respondent. To capture unobserved heterogeneity (i.e., unexplained heterogeneity), the studies largely estimated either a mixed logit (n = 205, 60%) or a latent-class logit (n = 112, 32.7%) model. Few studies (n = 38, 11%) explored scale heterogeneity or heteroskedasticity. CONCLUSIONS Providing preference heterogeneity evidence in health-related DCEs has been found as an increasingly used practice among researchers. In recent studies, controlling for unexplained preference heterogeneity has been seen as a common practice rather than explained ones (e.g., interactions), yet a lack of providing methodological details has been observed in many studies that might impact the quality of analysis. As heterogeneity can be assessed from different stakeholder perspectives with different methods, researchers should become more technically pronounced to increase confidence in the results and improve the ability of decision makers to act on the preference evidence.
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Affiliation(s)
- Suzana Karim
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Benjamin M Craig
- University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA
| | - Caroline Vass
- RTI Health Solutions, Manchester, UK
- The University of Manchester, Manchester, UK
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Patient Engagement in the Management of Benign Prostatic Hyperplasia. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Systematic Review of Patients' Values, Preferences, and Expectations for the Diagnosis and Treatment of Male Lower Urinary Tract Symptoms. Eur Urol 2021; 79:796-809. [PMID: 33461781 DOI: 10.1016/j.eururo.2020.12.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/11/2020] [Indexed: 01/01/2023]
Abstract
CONTEXT Understanding men's values and preferences in the context of personal, physical, emotional, relational, and social factors is important in optimising patient counselling, facilitating treatment decision-making, and improving guideline recommendations. OBJECTIVE To systematically review the available evidence regarding the values, preferences, and expectations of men towards the investigation and treatment (conservative, pharmacological, and surgical) of male lower urinary tract symptoms (LUTS). EVIDENCE ACQUISITION We searched electronic databases until August 31, 2020 for quantitative and qualitative studies that reported values and preferences regarding the investigation and treatment of LUTS in men. We assessed the quality of evidence and risk of bias using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) and GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approaches. EVIDENCE SYNTHESIS We included 25 quantitative studies, three qualitative studies, and one mixed-methods study recruiting 9235 patients. Most men reported urodynamic testing to be acceptable, despite discomfort or embarrassment, as it significantly informs treatment decisions (low certainty evidence). Men preferred conservative and less risky treatment options, but the preference varied depending on baseline symptom severity and the risk/benefit characteristics of the treatment (moderate certainty). Men preferred pharmacological treatments with a low risk of erectile dysfunction and those especially improving urgency incontinence (moderate certainty). Other important preference considerations included reducing the risk of acute urinary retention or surgery (moderate certainty). CONCLUSIONS Men prefer lower-risk management options that have fewer sexual side effects and are primarily effective at improving urgency incontinence and nocturia. Overall, the evidence was rated to be of low to moderate certainty. This review can facilitate the treatment decision-making process and improve the trustworthiness of guideline recommendations. PATIENT SUMMARY We thoroughly reviewed the evidence addressing men's values and preferences regarding the management of urinary symptoms and found that minimising adverse effects is particularly important. Further research to understand other factors that matter to men is required.
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Selman LE, Clement C, Ochieng CA, Lewis AL, Chapple C, Abrams P, Drake MJ, Horwood J. Treatment decision-making among men with lower urinary tract symptoms: A qualitative study of men's experiences with recommendations for patient-centred practice. Neurourol Urodyn 2020; 40:201-210. [PMID: 33053240 DOI: 10.1002/nau.24533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
AIMS To inform and guide patient-centred care for men with lower urinary tract symptoms (LUTS), by providing in-depth qualitative evidence regarding men's perspectives on treatment decision-making for LUTS. METHODS An interview study of men recruited from 26 English urology departments. Purposive sampling captured surgical/nonsurgical treatment decisions, and diversity in demographics and symptom burden, in men who had urodynamics and those who did not. After diagnostic assessments, men were interviewed either pre-treatment or after LUTS surgery. Thematic analysis was conducted. Participants' descriptions of how LUTS treatment decisions were made were categorised as patient-led, doctor-led, or shared. RESULTS A total of 41 men participated (25 pre-treatment, 16 post-surgery), ages 52-89. Twenty out of 41 described the treatment decision as shared with their consultant, 14 as doctor-led, and seven as patient-led. There was no obvious association between treatment decision-making style and patients' satisfaction with either clinicians' role in their decision or their treatment decision. Incomplete or rushed discussions and misperceptions of LUTS and its treatment were reported, indicating a risk of suboptimal decision-making support by clinicians. As well as clinician opinion, men's treatment decision-making was influenced by the results of urological assessments, comparing current symptoms with possible side-effects of surgery, and others' experiences and opinions. CONCLUSIONS Men with LUTS report and prefer different kinds of decision-making support from their clinicians, who must tailor their input to patients' preferences and needs. Patients' treatment decision-making involves multiple factors and can be challenging, and areas of inadequate clinician support were identified. Recommendations for patient-centred consultations about LUTS treatment are presented.
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Affiliation(s)
- Lucy E Selman
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cynthia A Ochieng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda L Lewis
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christopher Chapple
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK.,Translational Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
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Kovács A, Bücker A, Grimm MO, Habermann CR, Katoh M, Massmann A, Mahnken AH, Meyer BC, Moche M, Reimer P, Teichgräber U, Wacker FK. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. ROFO-FORTSCHR RONTG 2020; 192:835-846. [PMID: 32615637 DOI: 10.1055/a-1183-5438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In recent years prostate artery embolization (PAE) evolved into a clinically established minimally invasive endovascular treatment option for lower urinary tract symptoms caused by benign prostate syndrome (BPS). METHODS In this interdisciplinary position paper, initiated by the steering group for research of the German Society for Interventional Radiology (IR), the method of PAE is presented and discussed in the context of current evidence. RESULTS PAE is a safe IR procedure for the treatment of BPS. In terms of symptom relief, measured with the IPSS (International Prostate Symptom Score), the PAE has comparable effect, similar to the historic gold standard, transurethral resection (TUR) of the prostate. With regard to reducing subvesical obstruction PAE is inferior to TUR, but does not limit subsequent surgery. Based on current evidence, PAE is recommended by the British National Institute for Health and Care Excellence as an alternative therapy. The feasibility under local anaesthesia and the preservation of sexual function are important arguments for patients in favour of interventional therapy. Patient selection and therapy concepts require close interdisciplinary collaboration between urologists and radiologists. CONCLUSION Effectiveness and safety of PAE for the treatment of BPS are proven. Further randomized trials should focus on long term outcome and help to identify most suitable indications for PAE. KEY POINTS · PAE, an endovascular procedure, is a patient-friendly, minimally invasive, alternative therapy option of the BPS. · PAE can reduce the symptoms of the lower urinary tract (LUTS), comparable to transurethral resection (TUR). The deobstructive and volume-reducing potential of the PAE is inferior to that of the TUR. · The main advantages of PAE are use of local anesthesia (no general anesthesia required), short patient recovery and maintenance of sexual function, including antegrade ejaculation.. · Based on current evidence PAE should be considered after conservative drug therapy and before TUR.. · The role of PAE in the context of other minimally invasive procedures (MIST) requires further evaluation with an open minded approach towards PAE.. · PAE is carried out by interventional radiologists, usually on a referral basis from urologists, and requires close interdisciplinary cooperation.. CITATION FORMAT · Kovacs A, Bücker A, Grimm M et al. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. Fortschr Röntgenstr 2020; 192: 835 - 846.
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Affiliation(s)
- Attila Kovács
- MediClin Robert Janker Clinic, Clinic of Diagnostic and Interventional Radiology and Neuroradiology, Bonn, Germany
| | - Arno Bücker
- Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany
| | | | - Christian R Habermann
- Kath. Marienhospital Hamburg, Department of Diagnostic and Interventional Radiology, Hamburg, Germany
| | - Marcus Katoh
- Helios-Hospital Krefeld, Diagnostic and Interventional Radiology, Krefeld, Germany
| | - Alexander Massmann
- Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany
| | - Andreas H Mahnken
- Marburg University Hospital, Clinic of Diagnostic and Interventional Radiology, Marburg, Germany
| | - Bernhard C Meyer
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Michael Moche
- Helios-Park-Klinikum Leipzig, Department of Interventional Radiology, Leipzig, Germany
| | - Peter Reimer
- Städtisches Klinikum Karlsruhe, Academic teaching hospital of the University of Freiburg, Institute of Diagnostic and Interventional Radiology, Karlsruhe, Germany
| | - Ulf Teichgräber
- Jena University Hospital, Department of Radiology, Jena, Germany
| | - Frank K Wacker
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
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Cleland J, Porteous T, Skåtun D. What can discrete choice experiments do for you? MEDICAL EDUCATION 2018; 52:1113-1124. [PMID: 30259546 DOI: 10.1111/medu.13657] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT In everyday life, the choices we make are influenced by our preferences for the alternatives available to us. The same is true when choosing medical education, training and jobs. More often than not, those alternatives comprise multiple attributes and our ultimate choice will be guided by the value we place on each attribute relative to the others. In education, for example, choice of university is likely to be influenced by preferences for institutional reputation, location, cost and course content; but which of these attributes is the most influential? An understanding of what is valued by applicants, students, trainees and colleagues is of increasing importance in the higher education and medical job marketplaces because it will help us to develop options that meet their needs and preferences. METHODS In this article, we describe the discrete choice experiment (DCE), a survey method borrowed from economics that allows us to quantify the values respondents place on the attributes of goods and services, and to explore whether and to what extent they are willing to trade less of one attribute for more of another. CONCLUSIONS To date, DCEs have been used to look at medical workforce issues but relatively little in the field of medical education. However, many outstanding questions within medical education could be usefully addressed using DCEs. A better understanding of which attributes have most influence on, for example, staff or student satisfaction, choice of university and choice of career, and the extent to which stakeholders are prepared to trade one attribute against another is required. Such knowledge will allow us to tailor the way medical education is provided to better meet the needs of key stakeholders within the available resources.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Terry Porteous
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Diane Skåtun
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Ikenwilo D, Heidenreich S, Ryan M, Mankowski C, Nazir J, Watson V. The Best of Both Worlds: An Example Mixed Methods Approach to Understand Men's Preferences for the Treatment of Lower Urinary Tract Symptoms. THE PATIENT 2018; 11:55-67. [PMID: 28660567 DOI: 10.1007/s40271-017-0263-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are widely used to quantify individuals' preferences for healthcare. Guidelines recommend the design of DCEs should be informed by qualitative research. However, only a few studies go beyond guidelines by fully presenting qualitative and quantitative research jointly together in a mixed methods approach (MMA). OBJECTIVES Using an example study about men's preferences for medical treatment of lower urinary tract symptoms (LUTS), we demonstrate how qualitative research can complement DCEs to gain a rich understanding of individuals' preferences. METHODS We were the first to combine online discussion groups (ODGs) with an online DCE. A thematic analysis of the ODGs and a conceptual map provided insights into men's quality of life (QoL) with LUTS and relevant treatment attitudes. This was used to design the DCE. Men's willingness to pay (WTP) for these attributes was estimated. Findings from ODGs and DCE were compared to understand WTP and preference heterogeneity. KEY FINDINGS Men mostly valued medicine that reduced urgency and night-time frequencies of urination but avoided sexual side effects. We find heterogeneity in the effect of sexual side effects on men's preferences. The ODGs suggest this is because several men may be sexually inactive due to their age, being widowed or having comorbidities. The ODGs also raised concern about men's awareness of LUTS. CONCLUSION We argue that the insights gained into men's preferences for treatment and how LUTS affects men's QoL could not have been obtained by either the qualitative research or the DCE alone.
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Affiliation(s)
- Divine Ikenwilo
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Sebastian Heidenreich
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Colette Mankowski
- Astellas Pharma EMEA, 2000 Hillswood Drive, Chertsey, Surrey, KT16 0RS, UK
| | - Jameel Nazir
- Astellas Pharma EMEA, 2000 Hillswood Drive, Chertsey, Surrey, KT16 0RS, UK
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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