Increasing Decision Quality for Men With Lower Urinary Tract Symptoms
Increasing Decision Quality for Men With Lower Urinary Tract Symptoms
In this study, the investigators show that by upskilling of primary care physicians (PCPs) in
 SDM and leveraging on a novel pictorial Visual Analogue Uroflowmetry Score (VAUS), they can
 enhance older men's recognition of LUTS and stimulated discussion with their PCPs.
Lower urinary tract symptoms (LUTS), often related to prostatomegaly, is common but seldom
 sought medical attention amongst older men. Visual-aid and shared decision-making (SDM) are
 potential solutions to address LUTS. The study aimed to determine the effect of a novel
 pictorial Visual Analogue Uroflowmetry Score (VAUS) and primary care physicians (PCP) SDM
 training on the decisional quality amongst men selecting their treatment options for LUTS.

 This study recruited 60 multi-ethnic Asian men aged ≥50 years with moderate-to-severe LUTS
 (International Prostate Symptoms Score≥8 and/or QOL≥3) in a Singapore public primary care
 clinic. Men used the VAUS to report their symptoms. 60 men were randomly assigned to PCPs
 trained in SDM in the intervention group (n=30) and the other 30 to the control group (PCPs
 without SDM-training). Patient-physician dyad decision quality was measured using the
 validated SDMQ-9 (patient) and SDMQ-Doc (physician) questionnaires.
Inclusion Criteria:

 -  men aged 50 years old and older attending the polyclinic for routine follow up of a
 chronic disease (non-communicable disease)

 -  have moderate-to-severe LUTS and/or poor quality of life (QOL) as assessed by the
 validated International Prostate Symptom Score (IPSS) of eight or more and/or its
 individual QOL score of three or more

 -  men of any local Asian ethnicity and were willing to provide written consent

 -  can communicate with their allocated PCP in either of the three main local languages;
 English, Mandarin or Malay.

 Exclusion Criteria:

 -  have indwelling catheters

 -  urinary incontinence requiring diapers

 -  anuria due to any renal pathology

 -  gross hematuria

 -  acute urinary retention

 -  symptoms consistent with an acute urinary tract infection

 -  existing treatment of LUTS or other prostate pathology

 -  visual or hearing impairment which render men incapable of understanding the study
 procedure and providing informed consent

 -  men unwilling to discuss their LUTS treatment options with their PCP