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. 2019 Dec;30(12):2013-2022.
doi: 10.1007/s00192-019-04047-z. Epub 2019 Aug 3.

Development, validation and initial evaluation of patient-decision aid (SUI-PDA©) for women considering stress urinary incontinence surgery

Hui Ling Ong  1 , Inna Sokolova  2 , Holly Bekarma  3 , Claire Curtis  4 , Alastair Macdonald  5 , Wael Agur  6   7 ; NHS Ayrshire & Arran Continence Multidisciplinary Team
Affiliations

Development, validation and initial evaluation of patient-decision aid (SUI-PDA©) for women considering stress urinary incontinence surgery

Hui Ling Ong et al. Int Urogynecol J. 2019 Dec.

Abstract

Introduction and hypothesis: Following the design, face validation and publication of a novel PDA for women considering SUI surgery, the main objective of the study is to evaluate the usefulness of SUI-PDA© by using a validated tool to obtain patient feedback.

Methods: From July 2018 to March 2019, the PDA, already incorporated into the patient care pathway, was objectively evaluated using the Decisional Conflict Scale (DCS) to determine patients' views. Patients recorded their values and reasons for requests and declines of treatment. The total DCS score, scores from each DCS subgroup and individual patient responses were calculated and analysed.

Results: The mean age of the first 20 patients to complete the DCS was 54 years, the mean BMI was 30.1 and the median parity was 3. The average total DCS score was only 9.29 out of 100 (range 0-29.69) suggesting that the PDA was quite useful for patients considering SUI surgery. Overall, the PDA had largely favourable responses across all five DCS subgroups. The 'informed' subgroup had the best score (6.67) while the 'uncertainty' subgroup had the least favourable score (14.58). Despite the procedure pause, the mesh tape option remained on the PDA; however, no patient had chosen this option, with a large proportion citing 'safety' issues as the main reason. Bulking agent injections were the most popular choice (40.0%) and the most commonly performed procedures (50.0%) mainly because of quicker 'recovery'. The second most popular participant choice was colposuspension (35.0%) followed by autologous fascial sling (25.0%), with women citing 'efficacy' as the main reason behind their choice.

Conclusion: SUI-PDA© was reported by patients and clinicians to be useful with clinical decision-making for SUI surgery. Further validation in a larger patient group is underway.

Keywords: Decisional conflict scale; Patient decision aid; Stress urinary incontinence; Surgery.

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Conflict of interest statement

Wael Agur has received: trainer and speaker fees from CR Bard for training surgeons on mesh procedures for incontinence and prolapse, sponsorship from Boston Scientific for training on mesh procedures for prolapse, sponsorship from Neomedic for training on mesh procedures for incontinence, trainer and speaker fees from Contura/SEP Pharma, NHS Ayrshire and Arran, and the London Medical Education Academy, for training surgeons on non-mesh continence procedures; expert fees from NHS Scotland and various law firms in Scotland, England & Wales, The Republic of Ireland, the USA and Australia for the provision of medico-legal advice, expert report writing and/or appearance in court, on mesh litigation; and institutional research support as principal investigator for the SIMS Pilot, PROSPECT, VUE and PURSUIT studies. Wael Agur is also a member of an All Party Parliamentary Group on surgical mesh. Remaining authors claim no conflict of interest.

Figures

Fig. 1
Fig. 1
SUI-PDA development flowchart
Fig. 2
Fig. 2
‘What matters to me’ component of SUI-PDA
Fig. 3
Fig. 3
‘Treatment pathway’ component of SUI-PDA
Fig. 4
Fig. 4
‘Procedure comparison’ component of SUI-PDA
Fig. 5
Fig. 5
‘Request for Treatment’ component of SUI-PDA
See this image and copyright information in PMC

References

    1. Abrams,P, Cardozo, L, Wagg, A, Wein, A. (Eds) Incontinence 5th Edition (2013). ICI-ICS. International Continence Society, Bristol UK.
    1. NHS Digital 2018. Retrospective Review of Surgery for Urogynaecological Prolapse and Stress Urinary Incontinence using Tape or Mesh: Hospital Episode Statistics (HES), Experimental Statistics, April 2008 - March 2017. URL: https://digital.nhs.uk/data-and-information/publications/statistical/mes.... Accessed 3 May 2019.
    1. National Institute for Health and Care Excellence (NICE). Urinary incontinence in women. Clinical guideline no 171. 2013.
    1. Robinson, Anders, Cardozo, et al. What do women want? Interpretation of the concept of cure. J Pelvic Med Surg. 2003;9:273–277. doi: 10.1097/01.spv.0000095060.05452.3f. - DOI
    1. Stacey D et al. Decision aids for people facing health treatment or screening decisions (Review). Cochrane Database of Syst Rev. 2017;(4):CD001431. - PMC - PubMed

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