Sadik Joshua E, Lambrechts Sylvia, Kwan Lorna, Liu Hui, Shirk Joseph, Weiser Casey Elizabeth, Saigal Christopher
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Urol Pract. 2021 Jul;8(4):523-528. doi: 10.1097/UPJ.0000000000000234. Epub 2021 May 26.
Decision aids aimed at men with benign prostatic hyperplasia used in clinical trials have decreased the use of procedures and affected elements of decisional quality. We employed an online, interactive decision aid for men with benign prostatic hyperplasia as a routine part of care with a urologist and tracked subsequent treatment choice. We further evaluated the role of patient preferences on treatment selection.
Men scheduled for a new patient visit with a urologist for benign prostatic hyperplasia at a single tertiary care center were invited to use a decision aid prior to their visit. We compared treatment patterns in men who used the decision aid to a usual care group identified prior to the decision aid's introduction. Latent class analysis identified clusters of patients by their treatment preferences, which were then compared to their treatment choice.
The rate of procedures in the decision aid group was significantly lower than in the usual care group (6% vs 15%; p=0.0250), matching the rates reporting a procedure as their preferred treatment choice in the post-consult questionnaire (5% vs 15%; p=0.0082). Of the patients in our project 36% had never tried an alpha blocker prior to their urology consult. Latent class analysis found 2 clusters of patient preferences but without a significant association with final treatment selection.
Use of a decision aid was associated with a significant decrease in procedural management of benign prostatic hyperplasia. A high proportion of patients were evaluated by urologists without exhausting primary care management options.
在临床试验中使用的针对良性前列腺增生男性的决策辅助工具减少了手术的使用，并影响了决策质量的要素。我们将一种针对良性前列腺增生男性的在线交互式决策辅助工具作为泌尿科医生常规护理的一部分加以应用，并跟踪后续的治疗选择。我们进一步评估了患者偏好对治疗选择的作用。
在一家三级医疗中心，邀请计划首次就诊于泌尿科医生以治疗良性前列腺增生的男性在就诊前使用决策辅助工具。我们将使用决策辅助工具的男性的治疗模式与在引入决策辅助工具之前确定的常规护理组进行比较。潜在类别分析根据患者的治疗偏好确定聚类，然后将其与他们的治疗选择进行比较。
决策辅助工具组的手术率显著低于常规护理组（6% 对 15%；p = 0.0250），与在咨询后问卷中将手术作为其首选治疗选择的报告率相符（5% 对 15%；p = 0.0082）。在我们项目中的患者中，36% 在泌尿科咨询之前从未尝试过使用α受体阻滞剂。潜在类别分析发现了两类患者偏好，但与最终治疗选择无显著关联。
使用决策辅助工具与良性前列腺增生的手术治疗显著减少相关。很大一部分患者在未用尽初级护理管理选项的情况下就接受了泌尿科医生的评估。
