Understanding and Improving Treatment Decision-Making for Older Males with Stress Urinary Incontinence

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PROJECT SUMMARY/ABSTRACT: Male stress urinary incontinence (SUI) is common, costly, and significantly impacts health-related quality of life among older men, yet little is known about patient-centered outcomes in this population. Moreover, current patient counseling for male SUI treatment is based upon surgical outcomes, lacking guidance from patient- centered factors and patients’ underlying attitudes and beliefs about the importance of these various factors on treatment decisions and outcomes. Data are needed to understand how multi-morbidity, cognitive function, functional limitations, and life expectancy impact quality of life and decisional regret among older men who have made SUI treatment decisions. The long-term goal is to broaden our understanding of patient-centered outcomes in this population and to ensure treatments are aligned with patients’ overall goals. The objective of this application is to gain an understanding of quality of life and decisional regret among older men who have made SUI treatment decisions, and to understand the beliefs and motivations that drive these decisions. The central hypothesis is that there are geriatric-specific factors that impact quality of life and decisional regret among older men who have made SUI treatment decisions which go beyond those that are usually considered by surgeons counseling patients about these decisions. This hypothesis will be tested by utilizing a cohort of men ≥ 65 who have made SUI treatment decisions at the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center to pursue two specific aims: 1) To identify patient-, disease- and treatment-related factors associated with decisional regret and quality of life among older men who have made SUI treatment decisions; and 2) To understand the underlying beliefs and motivations driving treatment decisions among older men with SUI. This project is innovative because it is the first to focus on patient- centered outcomes in this patient population, goes beyond commonly measured surgical outcomes to bring geriatric principles to treatment decisions, and importantly, will be the first to identify what patient-identified treatment factors are important to older men considering SUI treatment. The proposed research is significant because it will improve patient counseling and informed decision-making among older adults facing treatment decisions for SUI, which is critical to patient-centered surgical care.