Patient Engagement, Patient Preference
Conditions
Brief summary
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.
Detailed description
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.
Interventions
BEHAVIORALPhysicians trained in shared decision making
Physicians in this group were trained in shared decision making
BEHAVIORALPhysicians were not trained in shared decision making
Physicians did not receive training in shared decision making
Sponsors
Singapore General Hospital
SingHealth Polyclinics
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
50 Years to No maximum
Healthy volunteers
Yes
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quality of the decision on the management of lower urinary tract symptoms from the patients' perspective | Through study completion, an average of 6 months | 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. |
| Quality of the decision on the management of lower urinary tract symptoms from the physicians' perspective | Through study completion, an average of 6 months | 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. |
Countries
Singapore
Outcome results
None listed