A staggering 33 million people in the U.S. alone1 – around 16% of the nation’s population – are affected by overactive bladder (OAB).
This was the opening of a fascinating talk by Dr. Ekene Enemchukwu, a female urologist, on the topic of shared decision making (SDM) in OAB during a two-hour breakfast meeting hosted by Astellas at this year’s Urology Care Foundation Advocacy Hub. The session featured three key speakers talking about methods to improve patient-centeredness in healthcare.
OAB is a condition caused by the brain’s loss of control over the bladder, leading to a frequent need to urinate and can be associated with a significant sense of stigma for those individuals affected.
When diagnosed though, there are many possible treatments. Behavioral and lifestyle therapies, bladder training, pelvic floor exercises, medications, procedures and surgery can all prove effective.
So why do so many people wait so long before approaching their physician? According to Enemchukwu, the reason behind these long waiting times is a sense of embarrassment, fear of talking to a doctor and general misinformation as to the causes and treatment of the condition.
Yet shared SDM between the person affected and their doctor can be part of the solution. “Patients better understand their condition through SDM, making it more likely that treatment will be successful,” she says. “This, in turn, can help raise awareness and destigmatize the condition.”
SDM means the patient and doctor formulating a management plan together based on clinical evidence, risks and benefits of therapy, and patient values. It is this last aspect – patient values – that is the most important, according to Enemchukwu. “For decades, there has been a push to change the longstanding culture of paternalism in medicine, which can be especially ineffective in the treatment of OAB, where individualized care is required.”
In contrast, Enemchukwu says that SDM often leads to improved treatment adherence, improved dialogue with the patient and greater patient satisfaction. It is important during those conversations that you weigh the pros and cons to determine the best approach to suit the individual’s lifestyle and expected quality of life factors. “We need to discuss the management options, empower patients to have those conversations with their doctor, and give them the resources they need to participate.” The meeting should not be a one-way street.
However, SDM doesn’t always occur. The process is often very complex and time-consuming for physicians who need to make time to address multiple medical issues in a short allotted time. Doctors need a streamlined SDM process, according to Enemchukwu, one that prepares patients to communicate with their doctors. Values based exercises using questionnaires that prompt patients to think about their preferences prior to their office visit can help the patient and their provider understand the patient’s individualized treatment preferences, thereby creating a more fruitful interaction.
Closing her talk, Enemchukwu spoke about her experience with one of her own patients, who she called Patty, 73, a very active grandmother who would often travel to visit her children and grandchildren. However, having started to experience increasing OAB symptoms, Patty stopped traveling to see her relatives due to fear of accidents and embarrassment.
Eventually, Patty was referred to Enemchukwu. The two talked through her symptoms and came up with a treatment plan that worked for her. Patty returned once the treatment stopped working and a second therapy was decided upon.
“The key take home message is SDM made her feel comfortable and empowered to return and discuss her other options,” says Enemchukwu. “We need to help make SDM a more efficient process, because we know that it can be such an effective tool.” This, she says, will help bring awareness of the impact OAB has and help people realize they don’t have to suffer alone.
- Urology Care Foundation. Overactive bladder. Accessed May 2017. Available at: http://www.urologyhealth.org/overactive-bladder