To evaluate the effectiveness of a web-based decision aid (DA) with values clarification exercises (VCEs) compared with usual care for men with lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH).
Between July 2016 and January 2017 all new LUTS/BPH patients who consulted the urologist were invited to use the DA and participate in this prospective questionnaire study. Patients who consulted the urologist between December 2015 and February 2016 served as controls. The DA was designed to support patients in making a well-informed treatment decision, corresponding with their personal preferences and values. Well-informed decision was measured by using a knowledge questionnaire. Value congruent decision was measured by the correspondence between responses on nine value statements and chosen treatment. The primary outcome, decision quality, was defined as the combination of well-informed decision and value congruent decision. Secondary outcomes were decisional conflict, involvement and received role in shared decision-making, decisional regret, and treatment choice.
A total of 109 DA-users and 108 controls were included. DA-users were younger (68.4 vs. 71.5; p=0.003) and education level was higher (p=0.047) compared with controls. Patients who used the DA made a well-informed and value congruent decision more often than controls (43% vs. 21%; p=0.028). DA-users had less decisional conflict (33.2 vs. 46.6; p=0.003), experienced a less passive role in decision-making (22% vs. 41%; p=0.038), and reported less process regret (2.4 vs. 2.8; p=0.034). Furthermore, DA-users who did not use prior medication chose lifestyle advices more often than controls (43% vs. 11%; p=0.002). Outcomes were adjusted for significantly different baseline characteristics.
The LUTS/BPH DA seems to improve the decision quality by supporting patients in making more well-informed and value congruent treatment decisions. Therefore, further implementation of this DA into routine care is suggested. This article is protected by copyright. All rights reserved.
BJU international. 2018 Dec 27 [Epub ahead of print]
Fieke C van der Wijden, Isabel B de Angst, Romy E D Lamers, Maarten Cuypers, Marieke de Vries, Harm H E van Melick, Jeltje S de Beij, Dennis J A J Oerlemans, Kees van de Beek, Paul J M Kil
Department of Urology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands., Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands., Institute for Computing and Information Sciences (iCIS), & Social and Cultural Psychology, Behavioural Science Institute, Radboud University, Mercator I, Toernooiveld 216, 6525, EC, Nijmegen, The Netherlands., Department of Urology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands., Department of Urology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands., Department of Urology, Laurentius Hospital, Monseigneur Driessenstraat 6, 6043 CV, Roermond., Department of Urology, Maastricht UMC+,, P. Debyelaan 25, 6229 HX, Maastricht.