Jessica Wynn, Yi-Ying Zeng, Kathryn McLeod
Furthering our understanding of patients' concerns regarding treatments for OAB, including BTX and SNS, can help patient-centered counseling, which is essential to delivering high-quality, individualized care. In our study, we found that participants expressed a preference for familiar, as well as simpler, less complex treatments. Participants were influenced by pre-existing perceptions that may not be anticipated by the clinician. Taking time to explore a patients' concerns and understanding can enhance shared decision-making and optimize clinical outcomes.
BACKGROUND AND AIMS: Overactive bladder (OAB) is characterized by urinary frequency and can be associated with urge urinary incontinence. OAB has a significant impact on quality of life if left untreated. Many patients may find their symptoms are refractory to medication or unable to tolerate medication side effects. Surgical treatments include sacral nerve stimulation (SNS) and intravesical Botulinum toxin injection (BTX). Surgeons may recommend SNS as the preferred treatment to patients with concomitant faecal symptoms who have an increased risk of poor bladder emptying or are unwilling or unable to perform intermittent self-catheterization, however, there is a subgroup of patients who elect to proceed with BTX treatments despite these concerns. We aim to investigate the decision-making process amongst the subset of patients who undergo BTX despite being preferred candidates for SNS.
METHODS: In this qualitative study, eligible participants with OAB who opted for Botox treatment despite being considered a preferred candidate for SNS by their treating clinician were invited to participate in a semi-structured interview. Patient understanding of both BTX and SNS options and their perceptions towards each treatment were explored. Data were analyzed using reflexive thematic analysis.
RESULTS: Ten participants were interviewed in this study, with a mean interview length of 29.5 min. Themes identified included: familiarity is reassuring, pre-existing perceptions, and keeping it simple.
CONCLUSION: Furthering our understanding of patients' concerns regarding treatments for OAB, including BTX and SNS, can help patient-centered counseling, which is essential to delivering high-quality, individualized care. In our study, we found that participants expressed a preference for familiar, as well as simpler, less complex treatments. Participants were influenced by pre-existing perceptions that may not be anticipated by the clinician. Taking time to explore a patients' concerns and understanding can enhance shared decision-making and optimize clinical outcomes.