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Development and randomised controlled trial of a Continence Product Patient Decision Aid for men post-radical prostatectomy

Development and randomised controlled trial of a Continence Product Patient Decision Aid for men post-radical prostatectomy
Development and randomised controlled trial of a Continence Product Patient Decision Aid for men post-radical prostatectomy
Aims and objectives: to develop and evaluate an evidence‐based Continence Product Patient Decision Aid (CP‐ PDA) to reduce decisional conflict and support continence product choice for men post‐radical prostatectomy.

Background: in 2018, 1.3 million men globally were diagnosed with prostate cancer. A common treatment is radical prostatectomy, usually leading to sudden‐onset of urinary incontinence. For people experiencing incontinence, products to contain leakage are fundamental to health‐related quality‐of‐life, but many product users and healthcare professionals are unaware of available options. No evidence‐based guidance on choosing products exists despite known physical and psychological burdens of poorly managed leakage (e.g. isolation, anxiety, depression, skin‐damage).

Design and Methods: 4 phases, underpinned by international decision‐aid guidance.

Evidence/expert opinion: literature review; consultation with specialist continence clinicians (n=7) to establish evidence‐base.

Prototype: CP‐PDA developed with continence specialist (n=7) feedback.
Alpha testing (stakeholders): CP‐PDA materials were provided to expert patients (n=10) and clinicians (n=11) to assess content/presentation.
Beta testing (field) following CONSORT guidelines, registered NIHR CPMS 31077: men (n=50) post‐radical prostatectomy randomised to evaluate usability and decision‐making using the Decisional Conflict Scale compared with usual care.

Results: an algorithm differentiating patients by mobility, dependency, cognitive impairment and type/level of leakage, leading to 12 user groups was developed. For each group, an option table and associated product information sheets guide product choice. Total Decisional Conflict Score for men using the CP‐PDA was significantly better than for men without. CP‐PDA users reported greater confidence in product knowledge and choice.

Conclusion: his is the first evidence‐based CP‐PDA, developed using an internationally recognised method. Compared to usual care, it significantly reduced decisional conflict for men choosing continence products post‐prostatectomy.

Relevance to clinical Practice: the CP‐PDA provides nurses with the first comprehensive, evidence‐based intervention to help post‐prostatectomy men in complex continence product choices. An online version is available: www.continenceproductadvisor.org.
absorbent pads, continence products, decision-making, incontinence, patient decision aid, prostate cancer, quality of life
0962-1067
2251-2259
Murphy, Catherine
b7f2dd56-3a8a-412a-9f6a-bf468ce7f749
De Laine, Christine
ef803c2f-cd45-4541-a093-5738fd5c19bc
Macaulay, Margaret
505970d3-1e67-4c1f-8291-3a950d336c6b
Fader, Miranda
c318f942-2ddb-462a-9183-8b678faf7277
Murphy, Catherine
b7f2dd56-3a8a-412a-9f6a-bf468ce7f749
De Laine, Christine
ef803c2f-cd45-4541-a093-5738fd5c19bc
Macaulay, Margaret
505970d3-1e67-4c1f-8291-3a950d336c6b
Fader, Miranda
c318f942-2ddb-462a-9183-8b678faf7277

Murphy, Catherine, De Laine, Christine, Macaulay, Margaret and Fader, Miranda (2020) Development and randomised controlled trial of a Continence Product Patient Decision Aid for men post-radical prostatectomy. Journal of Clinical Nursing, 29 (13-14), 2251-2259. (doi:10.1111/jocn.15223).

Record type: Article

Abstract

Aims and objectives: to develop and evaluate an evidence‐based Continence Product Patient Decision Aid (CP‐ PDA) to reduce decisional conflict and support continence product choice for men post‐radical prostatectomy.

Background: in 2018, 1.3 million men globally were diagnosed with prostate cancer. A common treatment is radical prostatectomy, usually leading to sudden‐onset of urinary incontinence. For people experiencing incontinence, products to contain leakage are fundamental to health‐related quality‐of‐life, but many product users and healthcare professionals are unaware of available options. No evidence‐based guidance on choosing products exists despite known physical and psychological burdens of poorly managed leakage (e.g. isolation, anxiety, depression, skin‐damage).

Design and Methods: 4 phases, underpinned by international decision‐aid guidance.

Evidence/expert opinion: literature review; consultation with specialist continence clinicians (n=7) to establish evidence‐base.

Prototype: CP‐PDA developed with continence specialist (n=7) feedback.
Alpha testing (stakeholders): CP‐PDA materials were provided to expert patients (n=10) and clinicians (n=11) to assess content/presentation.
Beta testing (field) following CONSORT guidelines, registered NIHR CPMS 31077: men (n=50) post‐radical prostatectomy randomised to evaluate usability and decision‐making using the Decisional Conflict Scale compared with usual care.

Results: an algorithm differentiating patients by mobility, dependency, cognitive impairment and type/level of leakage, leading to 12 user groups was developed. For each group, an option table and associated product information sheets guide product choice. Total Decisional Conflict Score for men using the CP‐PDA was significantly better than for men without. CP‐PDA users reported greater confidence in product knowledge and choice.

Conclusion: his is the first evidence‐based CP‐PDA, developed using an internationally recognised method. Compared to usual care, it significantly reduced decisional conflict for men choosing continence products post‐prostatectomy.

Relevance to clinical Practice: the CP‐PDA provides nurses with the first comprehensive, evidence‐based intervention to help post‐prostatectomy men in complex continence product choices. An online version is available: www.continenceproductadvisor.org.

Text
Development and randomised controlled trial of a Continence Product Patient Decision Aid for men post-radical prostatectomy - Accepted Manuscript
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More information

Accepted/In Press date: 7 February 2020
e-pub ahead of print date: 17 February 2020
Keywords: absorbent pads, continence products, decision-making, incontinence, patient decision aid, prostate cancer, quality of life

Identifiers

Local EPrints ID: 438152
URI: http://eprints.soton.ac.uk/id/eprint/438152
ISSN: 0962-1067
PURE UUID: e42ef31c-e1e1-45a7-bc94-bba575e6aa9f
ORCID for Margaret Macaulay: ORCID iD orcid.org/0000-0003-1737-4589

Catalogue record

Date deposited: 03 Mar 2020 17:43
Last modified: 22 Nov 2021 08:02

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