Women's experience with severe overactive bladder symptoms and treatment: insight revealed from patient focus groups.
ABSTRACT Research has focused on treatment of overactive bladder (OAB) symptoms in women with the goal of cure. The objective of this study was to assess women's perceptions of their OAB symptoms, treatment experience, and outcomes by conducting patient focus groups.
Women seen in our academic center female urology referral clinics were identified by ICD-9 codes for OAB symptoms and recruited to participate in one of five focus groups, totaling 33 patients. Non-clinician moderators conducted the focus group sessions incorporating topics related to patients' perceptions of OAB symptoms, treatments, and outcomes. Data analysis was performed using grounded theory methodology.
Qualitative analysis yielded several preliminary themes: impact of OAB on quality of life, strategies to control wetness, medications and side effects, and triggers. The majority of focus group participants reported only a partial response to medication and other physician-recommended treatments for OAB. Therefore, they developed self-reliant personalized strategies to improve their quality of life. These strategies included fluid restriction, preventive toileting, and, most importantly, the use of incontinence pads.
The majority of the women who participated in the focus groups reported only a partial response to medical and other treatments for OAB. As a result, they developed personalized self-management strategies to improve their quality of life. Although most studies addressing the treatment of OAB aim at curing the condition, such a strategy may be unrealistic. Applying a chronic care model that uses a patient-centered symptom-management approach to OAB may optimize patient outcomes and improve quality of life.
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ABSTRACT: Although having a regular primary care provider is noted to be beneficial to health, doctor shopping has been documented as a common treatment seeking behavior among chronically ill patients in different countries. However, little research has been conducted into the reasons behind doctor shopping behavior among patients with overactive bladder, and even less into how this behavior relates to these patients' illness and social experiences, perceptions, and cultural practices. Therefore, this study examines overactive bladder patients to investigate the reasons behind doctor shopping behavior. My study takes a qualitative approach, conducting 30 semi-structured individual interviews, with 30 overactive bladder patients in Hong Kong. My study found six primary themes that influenced doctor shopping behavior: lack of perceived need, convenience, work-provided medical insurance, unpleasant experiences with doctors, searching for a match doctor, and switching between biomedicine and traditional Chinese medicine. Besides the perceptual factors, participants' social environment, illness experiences, personal cultural preference, and cultural beliefs also intertwined to generate their doctor shopping behavior. Due to the low perceived need for a regular personal primary care physician, environmental factors such as time, locational convenience, and work-provided medical insurance became decisive in doctor shopping behavior. Patients' unpleasant illness experiences, stemming from a lack of understanding among many primary care doctors about overactive bladder, contributed to participants' sense of mismatch with these doctors, which induced them to shop for another doctor. Overactive bladder is a chronic bladder condition with very limited treatment outcome. Although patients with overactive bladder often require specialty urology treatment, it is usually beneficial for the patients to receive continuous, coordinated, comprehensive, and patient-centered support from their primary care providers. Primary care doctors' understanding on patients with overactive bladder with empathetic attitudes is important to reduce the motivations of doctor shopping behavior among these patients.BMC Family Practice 02/2014; 15(1):27. · 1.61 Impact Factor
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ABSTRACT: Perceptions about urinary incontinence (UI) may have a differential impact on treatment-seeking behaviors. Thus, we aimed to systematically review perceptions regarding UI in women of different racial and ethnic populations. MEDLINE, EMBASE, Scirus, Google Scholar, Open J-Gate, AgeLine, and Global Health (CABI) were searched from January 1980 to August 2011. We included qualitative studies that described knowledge, perception, or personal views about UI in women. Studies were excluded if they did not specify race/ethnicity of subjects, if they reported on non-UI urinary symptoms, or if they were performed exclusively in men. Three independent reviewers screened all studies. The relevance, appropriateness, transparency, and soundness (RATS) scale for qualitative research was used to assess study quality. Because of the qualitative data, meta-analyses were not performed. Of 3,676 citations, 23 studies met the inclusion criteria. Based on the RATS scale, these were categorized into 11 high-, 2 moderate-, and 10 low-quality studies. Dominant themes fell into two categories, UI management and UI experience, and were similar across racial/ethnic groups. Across multiple studies, women reiterated a preference for discussing UI with other women, even if this was not a physician. Non-white women expressed self-blame and perceived UI as a negative outcome from childbirth or prior sexual experiences. Latina women maintained more secrecy around this issue, even amongst family members. Women across different racial and ethnic groups share similar UI management strategies and UI experiences. However, perceptions about UI may differ in certain populations. These findings could be useful when considering future educational strategies regarding UI in women.International Urogynecology Journal 12/2013; · 2.17 Impact Factor
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ABSTRACT: To evaluate the efficacy and safety of once-monthly oxybutynin vaginal ring (Oxy VR) in women with overactive bladder (OAB). This randomized, multicenter, double-blind, 12-week Phase 2 study compared Oxy VR (4 or 6 mg/day) to a placebo VR in women with well-defined OAB symptoms. The primary efficacy variable was the change from baseline to Week 12 in the total weekly number of incontinence episodes (stress+urge). Safety was measured in terms of treatment-emergent adverse events, laboratory, physical, gynecological exams, ECG, and vital signs. Following a 3-week post-randomization placebo run-in-phase (n=720), 445 women entered the treatment-phase (safety population). Of these, 323 met all three OAB-specific baseline characteristics: ≥10 urinary urge incontinence (UUI) episodes/week, urinary frequency ≥8 episodes/week, and void volume ≤3 L/24 hours) (analysis population). Women treated with 4 and 6 mg/day Oxy VR had significantly fewer incontinence episodes/week (P=0.36 and P=0.18, respectively), less daily urinary frequency (P=0.014; P=0.002), and a higher proportion had no incontinence episodes at Week 12 (P=0.026; P=0.027) compared with placebo. The change in severity of urgency and void volume was similar for all groups (P>0.05). Except for a higher incidence of dry mouth and urinary tract infections that were not always culture-confirmed, Oxy VR was well-tolerated and had a safety profile similar to that of the placebo VR. Oxy VR appears to be an effective and safe once-monthly treatment option for women with OAB characterized primarily by urinary urge incontinence that merits further evaluation in a Phase 3 study.The Journal of urology 11/2013; · 3.75 Impact Factor