Enhanced Clinical Decisions for Management of Benign Prostatic Hyperplasia Using Patient-Reported Outcomes

利用患者报告的结果增强良性前列腺增生治疗的临床决策

• 批准号: 10698073
• 负责人: Alexander Paul Glaser
• 金额: $ 66.97万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10698073
• 关键词: Address; Aftercare; American; Anxiety; Benign Prostatic Hypertrophy; Bladder; Caring; Clinic; Clinical; Complex; Counseling; Data; Diagnosis; Dimensions; Distress; Electronic Health Record; Evaluation; Evidence based treatment; Extravasation; Functional disorder; Global Change; Goals; Guidelines; Health; Incontinence; Intervention; Language; Lower urinary tract; Malignant neoplasm of prostate; Measures; Medical; Mental Depression; Methods; Mind; Modeling; Modernization; Monitor; Nurses; Operative Surgical Procedures; Outcome Assessment; Overactive Bladder; Pain; Patient Care; Patient Outcomes Assessments; Patients; Phase; Physician Assistants; Population; Property; Prostate; Prostatic; Provider; Psychometrics; Qualitative Methods; Quality of Care; Quality of life; Questionnaires; Recommendation; Recovery; Research; Risk Factors; Secondary to; Severities; Sleep disturbances; Statistical Methods; Surgical Management; Symptoms; Technology; Telemedicine; Testing; Time; Update; Urinary Incontinence; Urinary tract infection; Urology; Work; associated symptom; bladder pain; care coordination; clinical care; clinical decision-making; clinical practice; comorbidity; cost effective; design; effective therapy; experience; follow-up; improved; indexing; instrument; intravesical; lower urinary tract symptoms; men; novel; patient oriented; persistent symptom; postoperative recovery; reduce symptoms; screening; side effect; symptom treatment; telehealth; tool; treatment as usual; treatment response; urinary; urologic

Project Summary The American Urological Association Symptom Index (AUA-SI) has been the primary patient-reported outcome (PRO) used in men with benign prostatic hyperplasia (BPH) for decades; however, it is not a comprehensive assessment of lower urinary tract symptoms that may present with BPH because it lacks items on urinary incontinence and bladder pain. The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) developed general-use multidimensional symptom questionnaires in order to address the complex needs of the urology clinic, but these tools have yet to be validated in specific clinical populations. The overarching goal of this project is to use these questionnaires and other PROs to enhance clinical decision-making in men with BPH. This will be achieved by (1) integration of PRO assessments into the evaluation and management of patients with BPH; (2) determination of clinically meaningful differences in LURN Symptom Indices in men with BPH receiving known effective treatment; and (3) creation of care-coordination recommendations to facilitate using PROs in order to match evidence-based treatments to patients with persistent symptoms. PROs are a cost- effective strategy that, combined with advances in electronic medical health record technology, can improve patient care by allowing for more real-time surveillance and intervention, including the monitoring of both the core urologic symptoms of BPH and common comorbid symptoms such as sleep disturbance and depression. In order to effectively determine meaningful symptom changes in response to treatment, minimally important differences specific to men with BPH must be established. Moreover, previously demonstrated convergent validity of the questionnaires must be confirmed in this population. In addition to using PROs to assess treatment response, they can also be used to monitor short-term side effects and comorbid conditions over the course of treatment, a practice that can facilitate care coordination that will increase quality of care and quality of life for men with BPH. In Aim 1, we will use statistical methods to predict changes in urologic symptoms and assess associations between lower urinary tract symptoms and measures of sleep disturbance, depression, and pain, among others. In Aim 2, we will assess test-retest reliability and other psychometric properties of the LURN Symptom Indices, using a triangulation of methods to determine minimally important differences. In Aim 3, we will engage stakeholders, including patients and clinicians, and use qualitative methods to create care coordination checklists intended for physician extenders to follow up with patients undergoing treatment, including via telehealth. Aim 3 will also enhance the recovery and routine monitoring of men with BPH after surgery, who can experience distressing side effects and complications such as urinary leakage and pain. The ultimate result of this work will be better understanding of the associations between comorbid sleep disturbance, depression, anxiety, etc., with urinary symptoms in men with BPH, and improved care and reduced symptom burden through the integration of robust and validated PROs into multiple phases of urologic care.

项目概要 美国泌尿外科协会症状指数 (AUA-SI) 是患者报告的主要结果 (PRO) 在患有良性前列腺增生 (BPH) 的男性中使用了数十年；然而，它并不是一个全面的 评估 BPH 可能出现的下尿路症状，因为缺乏有关泌尿系统的项目 失禁和膀胱疼痛。下尿路功能障碍的症状研究网络 (LURN) 开发通用的多维症状问卷，以满足患者的复杂需求 泌尿外科诊所，但这些工具尚未在特定临床人群中得到验证。总体目标是 该项目旨在利用这些问卷和其他 PRO 来增强 BPH 男性的临床决策。 这将通过 (1) 将 PRO 评估纳入患者的评估和管理来实现 患有良性前列腺增生； (2) 确定患有 BPH 的男性 LURN 症状指数有临床意义的差异 接受已知有效的治疗； (3) 制定护理协调建议以促进使用 PRO 旨在将循证治疗与持续症状的患者相匹配。 PRO 是一种成本 - 有效的策略，结合电子医疗健康记录技术的进步，可以改善 通过允许更多的实时监测和干预来提供患者护理，包括监测 BPH 的核心泌尿系统症状以及睡眠障碍和抑郁等常见合并症症状。在 为了有效地确定响应治疗的有意义的症状变化，最不重要 必须确定患有 BPH 的男性特有的差异。此外，先前证明的收敛性 必须在该人群中确认调查问卷的有效性。除了使用 PRO 来评估 治疗反应，它们还可以用于监测短期副作用和合并症 治疗过程，一种可以促进护理协调的做法，从而提高护理质量和质量 患有 BPH 的男性的生活。在目标 1 中，我们将使用统计方法来预测泌尿系统症状的变化和 评估下尿路症状与睡眠障碍、抑郁和睡眠障碍测量之间的关联 疼痛等。在目标 2 中，我们将评估 LURN 的重测可靠性和其他心理测量特性 症状指数，使用三角测量方法来确定最不重要的差异。在目标 3 中，我们 将让包括患者和临床医生在内的利益相关者参与进来，并使用定性方法来创造护理 协调清单供医生扩展人员跟进接受治疗的患者， 包括通过远程医疗。目标 3 还将加强前列腺增生症男性患者术后的康复和常规监测。 手术患者可能会经历令人痛苦的副作用和并发症，例如尿漏和疼痛。这 这项工作的最终结果将是更好地理解共病睡眠障碍之间的关联， 抑郁、焦虑等，患有 BPH 的男性伴有泌尿系统症状，改善护理并减轻症状 通过将强大且经过验证的 PRO 集成到泌尿科护理的多个阶段来减轻负担。