Making a decision about surgery for female urinary incontinence: a qualitative study of women’s views

TY - JOUR

T1 - Making a decision about surgery for female urinary incontinence

T2 - a qualitative study of women’s views

AU - Lynch, Rebecca

AU - Toozs-Hobson, Philip

AU - Duckett, Jonathan

AU - Tincello, Douglas

AU - Cohn, Simon

N1 - Funding Information: The study was funded by the UK National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme (14/70/162). Patient representatives from the UK’s Royal College of Obstetricians and Gynaecologists (RCOG) Women’s Voices network (an online panel of members of the public who have experiences of using women’s health services) were consulted when designing the study and applying for funding and remained involved as members of the project’s advisory board. They informed the design of the interview topic guide and data analysis through discussion and feedback of early findings and conclusions drawn. Funding Information: This work was funded by the UK National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme (14/70/162). Acknowledgements Publisher Copyright: © 2020, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/1

Y1 - 2021/1

N2 - Introduction and hypothesis: This qualitative interview study explores aspects women with urinary incontinence(UI) reflect upon when considering whether or not to have surgery. Conducted prior to the recent mesh pause in the UK, the article provides insights for current and future approaches to shared decision-making. Methods: Qualitative in-depth interviews of 28 patients referred to secondary care for stress and mixed UI who were considering UI surgery. Participants were recruited from four urogynaecology clinics in the Midlands and South England, UK. Interviews were conducted in clinics, in patient homes, and by telephone. Data analysis was based on the constant comparative method. Results: Participants’ accounts comprised three key concerns: their experience of symptoms, the extent to which these impacted a variety of social roles and demands, and overcoming embarrassment. Accounts drew on individual circumstances, values, and concerns rather than objective or measurable criteria. In combination, these dimensions constituted a personal assessment of the severity of their UI and hence framed the extent to which women prioritized addressing their condition. Conclusions: Acknowledging women’s personal accounts of UI shifts the concept of ‘severity’ beyond a medical definition to include what is important to patients themselves. Decision-making around elective surgery must endeavour to link medical information with women’s own experiences and personal criteria, which often change in priority over time. We propose that this research provides insight into how the controversy around the use of mesh in the UK emerged. This study also suggests ways in which facilitating shared decision-making should be conducted in future.

AB - Introduction and hypothesis: This qualitative interview study explores aspects women with urinary incontinence(UI) reflect upon when considering whether or not to have surgery. Conducted prior to the recent mesh pause in the UK, the article provides insights for current and future approaches to shared decision-making. Methods: Qualitative in-depth interviews of 28 patients referred to secondary care for stress and mixed UI who were considering UI surgery. Participants were recruited from four urogynaecology clinics in the Midlands and South England, UK. Interviews were conducted in clinics, in patient homes, and by telephone. Data analysis was based on the constant comparative method. Results: Participants’ accounts comprised three key concerns: their experience of symptoms, the extent to which these impacted a variety of social roles and demands, and overcoming embarrassment. Accounts drew on individual circumstances, values, and concerns rather than objective or measurable criteria. In combination, these dimensions constituted a personal assessment of the severity of their UI and hence framed the extent to which women prioritized addressing their condition. Conclusions: Acknowledging women’s personal accounts of UI shifts the concept of ‘severity’ beyond a medical definition to include what is important to patients themselves. Decision-making around elective surgery must endeavour to link medical information with women’s own experiences and personal criteria, which often change in priority over time. We propose that this research provides insight into how the controversy around the use of mesh in the UK emerged. This study also suggests ways in which facilitating shared decision-making should be conducted in future.

KW - Decision-making

KW - Surgery

KW - Surgical mesh

KW - Urinary incontinence

KW - women’s views

UR - http://www.scopus.com/inward/record.url?scp=85087124443&partnerID=8YFLogxK

U2 - 10.1007/s00192-020-04383-5

DO - 10.1007/s00192-020-04383-5

M3 - Article

AN - SCOPUS:85087124443

SN - 0937-3462

VL - 32

SP - 127

EP - 133

JO - International Urogynecology Journal

JF - International Urogynecology Journal

IS - 1

ER -