Goal achievement as a patient-generated outcome measure for stress urinary incontinence.

OBJECTIVES: To explore women's goals and goal attainment for the conservative and surgical treatment of stress urinary incontinence (SUI), and to examine the feasibility of Goal Attainment Scaling (GAS) as an outcome measure in this population. BACKGROUND: Despite the range of treatments for SUI, little is known about the outcomes patients consider important. Current instruments measure the impact of SUI on the ability to live a 'normal' life without addressing what normal looks like for the patient. Patient-generated measures that address what a patient aims to achieve may fill this gap. DESIGN: A mixed-methods exploratory design combined semi-structured interviews with validated questionnaires and individualized rating of goal achievement. SETTING AND PARTICIPANTS PARTICIPANTS: with SUI (n = 18) were interviewed in their homes prior to initiation of treatment and 3-6 months afterwards. MAIN VARIABLES: Participants reported individualized goals pre-treatment and rated goal attainment after surgical and conservative therapy. Quality of life impact and change were measured using short forms of the Incontinence Impact Questionnaire and Urinary Distress Inventory. RESULTS: Women expressed a median of four highly individualized treatment-related goals but goal achievement following conservative treatment was poor. GAS was not feasible as an outcome measure; women readily identified personal goals but could not independently identify graded levels of attainment for each goal. CONCLUSIONS: Although further work is needed to examine the most feasible, valid, and reliable method of measuring goal achievement in research, asking patients with UI to identify pre-treatment goals may provide useful information to guide treatment-related decision making.

Behavioral therapies for overactive bladder: making sense of the evidence.

Overactive bladder (OAB) is a symptom-based syndrome characterized by the presence of urgency, which is defined as a sudden and compelling desire to void that cannot be postponed. OAB may significantly impact of quality of life. Numerous treatment options exist for OAB, including behavioral therapies such as pelvic floor muscle rehabilitation, bladder training, and dietary modification, as well as traditional therapies such as pharmacological therapy and neuromodulation. Behavioral therapies are considered the mainstay of treatment for urinary incontinence in general. However the efficacy of these noninvasive strategies for OAB treatment has not been well addressed in the literature. This article presents an overview of current evidence with attention to the clinical relevance of findings related to lifestyle modification, bladder training, and pelvic floor muscle training. Initial evidence suggests that obesity, smoking, and consumption of carbonated drinks are risk factors for OAB but there is less support for the contributory role of caffeine or the impact of caffeine reduction. The evidence supporting bladder training and pelvic floor muscle training is more consistent and a trend towards combining these therapies to treat OAB appears positive. Given the prevalence of OAB and growing support for the efficacy of behavioral treatments it is important and timely to augment existing evidence with well-designed multicenter trials.

Men's experiences following laparoscopic radical prostatectomy: a qualitative descriptive study.

BACKGROUND: Laparoscopic radical prostatectomy is a less invasive surgical option to the open retropubic approach for prostate cancer that will likely grow in popularity commensurate with availability. However, since little is known about what men experience throughout the postoperative period, our ability to ensure informed decision-making remains compromised. OBJECTIVES: The aim of this study was to explore what men experience following laparoscopic radical prostatectomy and how adequately their pre- and postoperative needs are being met. DESIGN: This was a qualitative descriptive study. PARTICIPANTS: Nineteen men, aged 46-76, who had undergone laparoscopic radical prostatectomy within the previous 3-6 months period were recruited from the treatment and control arms of a randomized controlled trial. Men who were not in the trial were recruited via letters mailed from surgeons' offices. METHODS: Data were generated during loosely structured individual (n=5) and focus group interviews (n=3). Inductive content analysis helped to ensure that participants' perspectives were accurately represented. RESULTS: Men had actively sought information prior to surgery but seemed unprepared for the intensity of discomfort and incontinence they experienced. They particularly valued opportunities for informal discussion with former prostatectomy patients; however, erectile dysfunction remained a major concern and most did not know where to turn for help. CONCLUSION: Nurses could play a pivotal role in the laparoscopic radical prostatectomy experience by ensuring men are well informed both pre- and postoperatively. Facilitating contact with other men who have undergone laparoscopic radical prostatectomy (LRP) and initiating conversation about potential side-effects such as urinary incontinence and erectile dysfunction would be an important starting point. Particularly in light of early discharge and concerns regarding erectile dysfunction, additional follow-up seems warranted.

Factors impacting self-care for urinary incontinence.

INTRODUCTION: Behavioral strategies such as pelvic floor muscle exercises (PFME), bladder retraining, and dietary modifications are generally considered to be the first line of treatment for urinary incontinence (UI). Yet little is understood about the client's abilities/motivation to manage their UI in the home setting. Self-care, the ability of clients to act on their own behalf to achieve and maintain health, is a fundamental component of these strategies. Despite the frequently chronic nature of UI, there is growing evidence that such maintenance of behavioral therapies is sporadic at best. OBJECTIVE: The purpose of this study was to enhance understanding of self-care strategies that individuals with UI employ, the perceived benefits of these strategies, the factors that influence their self-care choices, and the factors that impede or facilitate maintenance of behavioral therapies. METHOD: In this qualitative descriptive study, individual and focus group interviews with community-dwelling participants were conducted to enhance understanding regarding the participants' management of UI at home and why they maintain certain strategies and not others. Data were collected via loosely constructed individual (n=25) and focus group (n=3) interviews to facilitate open discussion of participants' perceptions. RESULTS: Thirty-eight individuals (33 women and 5 men) participated in the study. Analysis of data resulted in a major category of self-care strategies related to UI that was further subcategorized into factors that facilitated PFME and barriers to PFME performance. Factors that facilitated PFME included: (a) realistic goals and expectation, (b) positive affirmation, (c) follow up, and (d) maintaining an exercise routine. Barriers noted were: (a) insufficient information, (b) characteristics of the exercises, (c) competing interests, (d) financial cost, and (e) minor psychosocial impact. CONCLUSIONS: This study described the self-care strategies that participants with UI had initiated and maintained and additionally explored the perceived facilitators and barriers to self-care choices. Two major themes emerged: (a) self-care efforts were motivated by desire for a normal daily lifestyle and (b) participants were motivated to maintain strategies by the ability to visualize progress and by knowledge that they were progressing. These findings support the need for client-focused teaching that is grounded in the individual's daily realities and goals.

Behavioral therapies at the primary care level: the current state of knowledge.

Urinary incontinence, the complaint of any involuntary loss of urine, is a troubling symptom experienced by men and women of all ages. Options for treatment include a range of behavioral, pharmacologic, and surgical therapies. Behavioral therapies, such as dietary modification, pelvic floor muscle training, and bladder training, are noninvasive, with little risk of side effects, and experts agree they should represent the first line of treatment whenever possible. These therapies can be initiated and monitored at the primary care level, thereby enhancing the accessibility of care for those affected. The purpose of this article is to methodically review what is and is not known about behavioral therapies, with attention to research needs. Although there is clear evidence for pelvic floor muscle training in women with urinary incontinence and modest evidence in men for a short time after radical prostatectomy, less is known about bladder training, prompted voiding, habit retraining, and timed voiding. Additional research is required to enhance our understanding of the comparative efficacy of behavioral interventions in specific populations. This research must take an increasingly long-term focus, given the potentially chronic nature of urinary incontinence.

An exploratory study of continence care services worldwide.

Urinary incontinence (UI) is a complex symptom of underlying disorders that affects over one and a half million Canadians. Although there is good evidence that incontinence can be treated effectively, the most efficient and cost-effective method for delivery of treatment is uncertain. The purpose of this study was to explore and describe the continence services that exist internationally and in Canada in order to provide the background for a Canadian model of continence service. Data were collected by communication with international health care professionals with expertise in UI, and distribution of a questionnaire to international and Canadian continence care providers. Findings suggest that although physicians, nurses, and/or physiotherapists currently provide continence care, services are scattered and inconsistent and discrepancies exist in how they are funded. The major themes that emerged are the need for enhanced accessibility of continence care and the importance of multidisciplinary teamwork.