Increasing Decision Quality for Men With Lower Urinary Tract Symptoms

SingHealth Polyclinics60 enrolled

Overview

In this study, the investigators show that by upskilling of primary care physicians (PCPs) in SDM and leveraging on a novel pictorial Visual Analogue Uroflowmetry Score (VAUS), they can enhance older men's recognition of LUTS and stimulated discussion with their PCPs.

Lower urinary tract symptoms (LUTS), often related to prostatomegaly, is common but seldom sought medical attention amongst older men. Visual-aid and shared decision-making (SDM) are potential solutions to address LUTS. The study aimed to determine the effect of a novel pictorial Visual Analogue Uroflowmetry Score (VAUS) and primary care physicians (PCP) SDM training on the decisional quality amongst men selecting their treatment options for LUTS. This study recruited 60 multi-ethnic Asian men aged ≥50 years with moderate-to-severe LUTS (International Prostate Symptoms Score≥8 and/or QOL≥3) in a Singapore public primary care clinic. Men used the VAUS to report their symptoms. 60 men were randomly assigned to PCPs trained in SDM in the intervention group (n=30) and the other 30 to the control group (PCPs without SDM-training). Patient-physician dyad decision quality was measured using the validated SDMQ-9 (patient) and SDMQ-Doc (physician) questionnaires.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Enrollment

Conditions

Patient Engagement Patient Preference

Interventions

Physicians trained in shared decision makingBEHAVIORAL

Physicians in this group were trained in shared decision making

Physicians were not trained in shared decision makingBEHAVIORAL

Physicians did not receive training in shared decision making

Eligibility

Sex: MALEMin age: 50 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * men aged 50 years old and older attending the polyclinic for routine follow up of a chronic disease (non-communicable disease) * have moderate-to-severe LUTS and/or poor quality of life (QOL) as assessed by the validated International Prostate Symptom Score (IPSS) of eight or more and/or its individual QOL score of three or more * men of any local Asian ethnicity and were willing to provide written consent * can communicate with their allocated PCP in either of the three main local languages; English, Mandarin or Malay. Exclusion Criteria: * have indwelling catheters * urinary incontinence requiring diapers * anuria due to any renal pathology * gross hematuria * acute urinary retention * symptoms consistent with an acute urinary tract infection * existing treatment of LUTS or other prostate pathology * visual or hearing impairment which render men incapable of understanding the study procedure and providing informed consent * men unwilling to discuss their LUTS treatment options with their PCP

Locations (1)

Haidee Ngu

Singapore, Singapore

Outcomes

Primary Outcomes

Quality of the decision on the management of lower urinary tract symptoms from the patients' perspective

The Shared Decision Making-9 (SDMQ9) Questionnaire measures decision quality from the perspective of the patient. Nine individual items in the questionnaire is scored from 0 to 5 on a six-point Likert scale ranging from 0 ("completely disagree") to 5 ("completely agree"). Standard scoring for the full scale is the total score, with values from 0 to 45. Higher scores indicate higher quality decisions.

Time frame: Through study completion, an average of 6 months

Quality of the decision on the management of lower urinary tract symptoms from the physicians' perspective

The Shared Decision Making-Doctor (SDMQDoc) Questionnaire measures decision quality from the perspective of the physician. Nine individual items in the questionnaire is scored from 0 to 5 on a six-point Likert scale ranging from 0 ("completely disagree") to 5 ("completely agree"). Standard scoring for the full scale is the total score, with values from 0 to 45. Higher scores indicate higher quality decisions.

Time frame: Through study completion, an average of 6 months

Data from ClinicalTrials.gov

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