Empowering patient choice: a systematic review of decision aids for benign prostatic hyperplasia

Abstract

Background: Benign prostatic hyperplasia (BPH) is a complex condition that affects ~3.2 million men in the UK. As men often face multiple treatment options, discussion and consideration of their priorities and preferences is necessary; however, research indicates this is not always adopted in practice.

Objectives: To evaluate decisional interventions currently available for men with symptomatic BPH, distinct from those designed for prostate cancer.

Methods: Eight databases (PubMed, Web of Science, EBSCO, Science Direct, Scopus, Google, Cochrane Library, Centre for Reviews and Dissemination) were searched retrieving a total of 1979 results, of which 13 international studies discussing 10 decision aids (DAs) were included. Studies were eligible that targeted adult males experiencing urological symptoms and discussed any DA designed to promote shared decision making within secondary healthcare.

Results: Narrative synthesis found most DAs focused on treatment information provision; however, risk information was not always equally presented. Most DAs lacked strong theoretical links to existing theories on behaviour change, risk communication, and decision making, and sustained implementation within clinical practice. The most effective aids went beyond information provision, to also elicit and integrate patient preferences and values, by adopting multiple behaviour change techniques (BCTs). Risk of bias indicated medium risk with limited information or justification on data collection and analysis methods.

Conclusion: Current DAs relevant to BPH lack clear focus on individual patient needs required for delivering patient-centred care. Greater transparency and explicit links to behavioural theory and BCTs related to desired future outcomes, expectations, and values are required to effectively create and implement effective interventions into urological practice.

Keywords: BPH; decision aid; prostate; shared decision making; systematic review; urology.