A study of factors that influence the choice of primary surgical procedure for stress urinary incontinence from the perspective of patients and clinicians

Abstract

Introduction: Operations available to treat SUI range from office-based procedures to significant pelvic surgery. These procedures have individual risk and benefit profiles and it is currently unknown what factors women with SUI consider when deciding upon a surgical procedure. It is also unknown what factors clinicians consider when they counsel and offer procedures to women and how this may influence the overall procedure chosen. This research aimed to investigate the factors considered by both groups when choosing a primary surgical procedure for SUI. Method: Qualitative semi-structured interviews were conducted with 14 women with SUI who had recently opted for a primary surgical procedure. Women were purposively sampled to ensure that those who had chosen each available operation were represented. Fifteen consultant urogynaecologists from 11 hospitals across the North of England were interviewed. Interviews were analysed by thematic analysis using the framework method. Results: Women were influenced by the views and experiences of others outside of the clinical team and valued experiential information in their decision-making. They also had key internal values they considered important, such as return to normal activities, success and risk. Their attitude towards certain procedural factors, such as type of anaesthetic, use of a foreign body and the need for incisions were also considered. Women attached differing levels of importance to these factors and raked them in terms of this. These hierarchies were compared to characteristics of offered surgical procedures and the procedure that best fit was selected. Clinicians considered clinical factors, including age, BMI, anatomy, severity of SUI and family completion status, to be important when considering surgery. Clinicians appeared to have individualised cut offs for these, with some clinicians limiting the options they gave women depending upon these factors. These cut offs were influenced by training and personal clinical experience in many cases. Directed counselling was used by some, especially for women with perceived high-risk characteristics. Clinicians appeared to have the ultimate decisional power of which procedure to proceed with, appearing to sign off any decision made by women. Conclusion: The overall decision of primary surgical procedure is complex, with preferences being formed by both patients and clinicians. This study highlights the need to investigate and formally recognise women’s feelings towards the key values identified, as this will significantly influence their preferences. There is also a need to incorporate experiential information in to the counselling process to better support women in their decision making. This study showed a variation in surgical threshold between clinicians. This should be further researched as it could lead to an inequality of choice for patients

Date of Award	1 Aug 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Fiona Reid (Supervisor), Rachael Powell (Supervisor) & Richard Edmondson (Supervisor)