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.

项目摘要 美国泌尿外科协会症状指数（AUA-SI）是患者报告的主要结局 (PRO)用于男性良性前列腺增生（BPH）几十年;然而，它不是一个全面的 评估下尿路症状，可能存在BPH，因为它缺乏泌尿系统项目 失禁和膀胱疼痛。下尿路功能障碍的症状研究网络（LURN） 开发了通用的多维症状问卷，以解决复杂的需求， 泌尿科临床，但这些工具尚未在特定的临床人群中得到验证。的首要目标 本项目旨在使用这些问卷和其他PRO来增强BPH男性患者的临床决策。 这将通过（1）将PRO评估整合到患者的评价和管理中来实现 （2）确定BPH男性患者LURN症状指数的临床有意义差异 接受已知的有效治疗;（3）创建护理协调建议，以促进使用 PRO，以便将循证治疗与持续症状的患者相匹配。成本是一种成本-- 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，包括监测患者的 BPH的核心泌尿系统症状和常见的共病症状，如睡眠障碍和抑郁症。在 为了有效确定治疗后有意义的症状变化，最低限度重要 必须确定BPH男性的特异性差异。此外，以前证明收敛 调查表的有效性必须在这一人群中得到确认。除了使用PRO来评估 治疗反应，他们也可以用来监测短期的副作用和共病的条件下， 治疗过程中，可以促进护理协调，将提高护理质量和质量的做法 前列腺增生症患者的生活。在目标1中，我们将使用统计方法预测泌尿系统症状的变化， 评估下尿路症状与睡眠障碍、抑郁和 疼痛，除此之外。在目标2中，我们将评估LURN的重测信度和其他心理测量学特性 症状指数，使用三角测量的方法来确定最小的重要差异。在目标3中，我们 将与包括患者和临床医生在内的利益相关者合作，并使用定性方法来创建护理 协调检查表，用于医生扩展员对接受治疗的患者进行随访， 包括通过远程保健。目标3还将加强BPH患者的恢复和常规监测， 手术，谁可以体验痛苦的副作用和并发症，如尿漏和疼痛。的 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，焦虑等等，前列腺增生症患者的泌尿系统症状，并改善护理和减少症状 通过将稳健和经验证的PRO整合到泌尿科护理的多个阶段中，减轻负担。