(Poster 109) Shared Decision Making for Urinary Incontinence in Primary Care

Objectives: The majority of women experiencing urinary incontinence (UI) seek care through their primary care provider (PCP). Research suggests UI management by PCPs can be characterized by low adherence to quality-of-care indicators and disparities based on race/ethnicity and language. Shared decision-making (SDM) is an approach to navigating treatment options that prioritizes patient autonomy in the clinical decision-making process, though there have yet to be quantitative assessments of SDM for female UI care. We sought to evaluate the SDM of women seeking UI treatment with their PCP and determine the impact of patient language, knowledge of UI, and severity of symptoms on patient perception of SDM.

Methods: Female patients at two medical centers (one private and one public) were recruited for this study evaluating UI care by PCPs. Patients with upcoming appointments with their PCP were eligible if they reported new or worsening UI not addressed with a specialist within the past two years. Patients completed a demographic questionnaire upon enrollment which included age, race and ethnicity, and languages spoken. Knowledge of UI was assessed by Pelvic Floor Awareness and Knowledge Survey (PFAKS), and severity of UI was measured by the Urinary Distress Inventory, Short Form (UDI-6) and the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF) at enrollment. Three months after enrollment, patients repeated the previous questionnaires in addition to the 9-item Shared Decision Making Questionnaire (SDMQ-9) to assess their perception of SDM at their PCP visit. Nonparametric analysis was performed with Pearson correlations and Wilcoxon-Rank Sum tests.

Results: In total, 103 patients with a mean age of 62.7 were recruited. Seventy-five patients (72.82%) spoke English, 21 (20.39%) spoke Spanish, and 7 (6.80%) reported being bilingual. Out of a score of 100, participants had a mean SDMQ-9 of 40.21. SDMQ-9 scores were not associated with symptom severity (via ICIQ-SF and UDI-6 scores) or patient knowledge (via PFAKS scores) at baseline or 3 months (Table 1). There was also no significant difference in SDMQ-9 scores when comparing English speaking, Spanish speaking, and bilingual patients (Table 2).

Conclusions: In our study of women seeking care for UI with their PCP, SDM scores did not correlate with UI symptom severity or patient knowledge of PFDs, and there were no differences in SDM scores based on primary language spoken. These findings are encouraging given that language barriers are known to influence the quality of UI care. As SDM is treatment-specific, conclusions are limited given that quantified measures for SDM have yet to be well described for female UI care. SDM may be more closely tied to the quality of care provided at the primary care level, indicate a need for further investigation into the SDM of female UI care.