Improving urinary and sexual dysfunction after prostate surgery using shared decision making

项目总结

PROJECT SUMMARY Shared decision making (SDM) is a concerted effort between clinicians and patients to select care plans that balance evidence with patient preferences and values. Shared decision making has been identified as a key component of high- quality health care delivery and has been proposed as a quality metric for physician reimbursement. However, a disconnect exists between support of SDM by healthcare providers and policymakers, and the implementation of SDM in practice. Furthermore, there is a lack of measures to assess SDM, which may be impeding its clinical use. Despite this, SDM has been mandated and recommended at a policy level both nationally and within guideline statements. In light of this, providing data about real-world use of SDM in urology and developing meaningful measures of SDM is imperative. The factors that lead to use of decision aids and shared decision making by urologists are largely unknown and few have studied the association between SDM and urologic outcome measures that are salient to clinicians and patients. Using a large, prospectively collected, state-wide database of patient reported outcomes (PRO) linked among patients who have used a decision aid prior to prostate surgery, we will assess the practice and patient level factors that facilitate decision aid use and evaluate the link between decision aids and patient reported urologic outcomes. We hypothesize that both practice factors and patient attributes will influence the likelihood of using a decision aid. We also predict that those who use a decision aid prior to undergoing prostate surgery will have improved patient reported outcome measures, as measured by urinary incontinence and erectile dysfunction bother scores on validated instruments. This proposal will be the first to analyze the results of a large, community based, shared decision making initiative. Furthermore, it will fill a critical knowledge gap in the link between use of shared decision making and patient reported outcome measures. In the era of patient centered care, these findings will help inform efforts to implement shared decision making in urologic practice.