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Patient preferences and expectations in OAB

Highlights of the systematic review by Cicione A., Lombardo R., Umbaca V. et al. published in the Journal of Clinical Medicine in 2023

The aim of this study was to examine, based on the literature currently available on the topic, the preferences and expectations of patients in terms of the management of overactive bladder (OAB). 

 

What was the purpose of this study?

OAB is a storage symptom syndrome whose pathophysiology remains poorly understood and its true aetiology is unknown. The current management approach relies on lifestyle changes (first-line treatment), medication, and surgery. Treatment of OAB with this linear approach, based on invasiveness of treatment remains challenging for doctors, due to their moderate efficacy and side effects, often resulting in a poor adherence. And finally, around one in two patients experiencing discomfort due to OAB have consulted a doctor, and less than a quarter have received treatment.
Some authors have suggested that treatment adherence could be improved by enhancing the interaction between physician and patient and cost ‘effectiveness, through a patient-centred care and shared decision making (SDM).
That is why a better understanding of patient preferences and expectations is essential to help doctors choose the most appropriate therapeutic option for each of their OAB patients.

 

How was the study undertaken?

A literature search was carried out in September 2022 to identify studies that had been published on the topic. Three online databases - PubMed/Medline, Embase et Scopus - and a combination of keywords were used. A total of 1,349 studies had been published, but only 10 were deemed relevant to the objectives set. 

 

What were the study results?

 Medical TreatmentInvasive Treatment
Patient preferencesAn oral treatment which reducesurgency, frequency and incontinence episodes, with no effect on cognitive function and coveredby insurance.
  • 3rd line treatments (i.e., sacral neuromodulation (SNM), onabotulinim toxin and/or percutaneous tibial nerve stimulation(PTNS)) are preferred over ideal conduit.
  • Patient decision is influenced by device interactivity, effectiveness on continence and micturition frequency

 

What are the takeaways from this study?

Based on this analysis, the ideal medical treatment according to patients should be affordable, have no effects on cognitive function, and be capable to reduce daytime urinary frequency and incontinence episodes. Currently, the importance of sharing decisions on treatment with patients has long been recognized.
Considering a “patient-based approach” instead of “one size fits all” strategy, taking into account patient's preference and expectations, may help in rising to the challenge scenario of OAB patients medical treatment, and improve adherence and satisfaction to medications.
Standardized method in the evaluation of patient's preferences and expectations is still lacking, so it is very important to develop a validated and universal method to assess patients’ preferences and expectations. It could help to allow a better understanding, better analysis, and identifying possible differences based on social and demographic characteristics.
 

Source:
Cicione, A.; Lombardo, R.; Umbaca, V.; Tema, G.; Gallo, G.; Stira, J.; Gravina, C.; Turchi, B.; Franco, A.; Mancini, E. et al. Patients’ Preferences and Expectations in Overactive Bladder: A Systematic Review. J. Clin. Med. 2023, 12, 396. https://doi.org/10.3390/jcm12020396

HQ--02-24-2400009 – 02/2024