Improving Patient-Centered Decision-Making for Stress Urinary Incontinence Treatment in Older Men

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PROJECT SUMMARY/ABSTRACT This is a Beeson K76 career development award for Dr. Lindsay Hampson, a clinician investigator with a background in ethics, health services research, and stress urinary incontinence (SUI). Dr. Hampson is pivoting her career towards aging, with a goal of becoming a national leader in geriatric urology research focused on achieving goal-concordant care for older adults with urologic issues that affect quality of life (QOL) through reducing treatment disparities and improving treatment decision-making. This proposal seeks to improve goal-concordant management for post-prostatectomy SUI among older adults by: 1) identifying drivers of disparities in the care of older post-prostatectomy men, 2) determining treatment preferences and priorities of this patient population, and 3) promoting individualized evaluation and treatment decision-making in the context of geriatric-informed health and values. Significance: Post-prostatectomy SUI significantly impacts QOL, disproportionately impacting older men. Despite a focus on reducing treatment of prostate cancer, one quarter of men 65-75 years of age diagnosed with prostate cancer will still undergo prostatectomy. An estimated 25-30% of men are using pads, diapers, or complaining of bothersome incontinence beyond one year following prostatectomy, and these rates likely represent underestimation of continence rates in older men. SUI surgery has been shown to result in near-term QOL improvements with high satisfaction rates, yet is severely underutilized and delayed, and men facing treatment decisions have substantial decisional regret. In Aim 1’s national cohort study using Veterans Affairs and Medicare data, we aim to identify factors associated with post-prostatectomy SUI under-treatment and treatment delays among older men. In Aim 2’s discrete choice experiment survey of older post-prostatectomy men, we aim to identify patient-centered SUI treatment priorities and understand how these preferences vary based on characteristics associated with access to care. These data will be utilized to develop an Incontinence Post-Prostatectomy Assessment & Decision Support (I- PADS) tool which will be evaluated in Aim 3 through a mixed methods study and feasibility/acceptability trial. Mentoring team: Dr. Hampson’s exceptional multidisciplinary mentoring team is led by Dr. Louise Walter, an internationally recognized expert on individualized decision making for in older adults. This award will support Dr. Hampson’s transition to aging research through dedicated training in 1) conducting national cohort studies of older adults, 2) developing expertise in measuring treatment preferences, 3) implementation science theory and methods to implement interventions for older adults, and 4) leadership in geriatric urology to become a leader in goal-concordant urologic care among older adults by reducing treatment disparities and improving treatment decision-making. Next Steps: These results will serve as the foundation for a multicenter hybrid implementation-effectiveness study of the I-PADS tool to test its effect on addressing disparities in SUI surgery, decisional and treatment regret, and receipt of goal-concordant care for post-prostatectomy SUI.