Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, The University of Chicago, Chicago, Illinois.
Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
J Urol. 2021 Nov;206(5):1240-1247. doi: 10.1097/JU.0000000000001950. Epub 2021 Jun 29.
We aimed to understand the reasons patients choose to pursue third-line overactive bladder (OAB) therapy.
We conducted a mixed methods study that included patient interviews and survey data. Eligible patients were diagnosed by symptoms, had tried behavioral modifications, and OAB medications enrolled from October 2018 to August 2019. In addition to interviews, patients completed 4 surveys: the Pelvic Floor Distress Inventory, Overactive Bladder Questionnaire Short Form, Life Orientation Test-Revised, and a patient confidence in the health care system survey. Qualitative interview data were analyzed thematically. Logistic regression and chi-square analysis was used to analyze survey data.
A total of 69 patients were consented, 4 withdrew, and 51 completed both interview and survey data. Overall 55% of patients were Caucasian, 45% were African American, and their average age was 71 (SD=10.4); 75% intended to pursue third-line OAB therapy and 31 (61%) expressed interest in a specific third-line therapy. Major interview themes included a desire for a better quality of life, embarrassment with accidents, and problems with medication. Themes leading patients away from third-line OAB treatment included concern about invasiveness and side effects of treatments, and restrictions to accessing care.
Most patients desired to progress to third-line OAB therapy, were motivated by embarrassment, but were concerned about treatment side effects. We found that economic burden of OAB treatment is associated with patient interest in and decision to receive third-line therapies to include onabotulinumtoxinA and percutaneous tibial nerve stimulation. Improved quality of life, medication frustration, and concerns about side effects of further therapy are themes patients identified when patients considered third-line overactive bladder therapy.
我们旨在了解患者选择三线治疗过度活跃膀胱（OAB）的原因。
我们进行了一项混合方法研究，包括患者访谈和调查数据。合格的患者是根据症状诊断的，已经尝试了行为改变和 OAB 药物治疗，于 2018 年 10 月至 2019 年 8 月招募。除了访谈外，患者还完成了 4 项调查：盆底不适量表、OAB 问卷简表、生活取向测验修订版和患者对医疗保健系统的信心调查。对定性访谈数据进行主题分析。使用逻辑回归和卡方分析对调查数据进行分析。
共同意 69 名患者，4 名患者退出，51 名患者完成了访谈和调查数据。总体而言，55%的患者为白种人，45%为非裔美国人，平均年龄为 71（SD=10.4）；75%的患者打算接受三线 OAB 治疗，31%（61%）对特定的三线治疗感兴趣。主要访谈主题包括对更高生活质量的渴望、对意外的尴尬和药物治疗问题。导致患者远离三线 OAB 治疗的主题包括对治疗的侵袭性和副作用的担忧，以及获得治疗的限制。
大多数患者希望接受三线 OAB 治疗，受到尴尬的驱使，但对治疗的副作用感到担忧。我们发现，OAB 治疗的经济负担与患者对接受三线治疗的兴趣和决定有关，包括肉毒杆菌毒素 A 和经皮胫神经刺激。改善生活质量、药物挫折和对进一步治疗副作用的担忧是患者在考虑三线过度活跃膀胱治疗时确定的主题。
