Shared decision-making across the urinary incontinence care continuum: implications for patient-centered care.

PURPOSE OF REVIEW: Despite the high prevalence of urinary incontinence, many women do not receive care. Urinary incontinence requires multiple personalized decisions across the care continuum. This review examines how shared decision-making and decision science may inform efforts to improve the delivery of patient-centered urinary incontinence care. RECENT FINDINGS: Recent literature describes the complexity of patients' decision-making across multiple stages of the urinary incontinence care continuum, including deciding whether to mention urinary symptoms, to seek an appropriate clinician or care setting, to select a treatment, and to initiate or complete treatment. Barriers include limited knowledge, stigma, symptom normalization, treatment concerns, competing priorities, clinician communication, and health system barriers. Existing urinary incontinence decision support research has focused primarily on patient decision aids for treatment selection. These tools appear promising for reducing decisional conflict and uncertainty, but current studies are limited by nonrandomized designs, a narrow focus on treatment selection, inconsistent evaluation of decision-quality outcomes, and limited attention to urinary incontinence outcomes and implementation. SUMMARY: Patient-centered urinary incontinence decision-making should address decision needs across the full continuum of care. Future research would benefit from increased scientific rigor, support for understudied phases of the care continuum, ascertainment of clinical outcomes, and evaluation of implementation strategies that support high-quality decisions in routine clinical practice.