Women’s preferences for surgical treatments of urinary incontinence: a discrete choice experiment

Session: 

Oral session: Qualitative evidence synthesis methodology

Date: 

Sunday 16 September 2018 - 15:10 to 15:20

Location: 

Carrick 2

All authors in correct order:

Ternent L1, Becker F2, Craig D1
1 Newcastle University, UK
2 Oxford University, UK
Presenting author and contact person

Presenting author:

Dawn Craig

Contact person:

Dawn Craig
Abstract text
Background: Urinary incontinence (UI) is a common clinical condition that affects quality of life substantially. While some of the available surgical treatments have more frequent and severe complications, there is no evidence comparing the effectiveness and cost-effectiveness of all surgical techniques. More information including women’s preferences for different aspects of the surgery is required to enable them to make an evidence-based choice while informing practice guidelines around the management and treatment of UI.

Methods: An online survey containing a discrete choice experiment (DCE) was designed to explore women’s preferences for different aspects of surgical treatments. Five attributes framed the hypothetical scenarios: adverse events, chronic pain, length of hospital stay, time to return to normal activities, and risk of recurrence during the 12 months after surgery. The analytic approach considered conditional and mixed logit models to account for preference heterogeneity.

Results: Responses from a general population sample of women (n = 789) have been collected by means of an online panel. The sample consisted of 436 non-patients and 353 patients who suffered from one or more types of UI. Results suggest that, in general, women would prefer a surgical treatment over no surgery; this preference was stronger for patients, but was mediated by the respondent’s health status. As expected, respondents preferred shorter hospital stays and surgical treatments that were associated with a lower risk of recurrence. While preferences for chronic pain did not vary between groups, patients appeared to care less about adverse events and more about a shorter period to return to normal activities. Infections and pain during intercourse were preferred compared to the reference category of new urinary symptoms, while damage to organs or nerves and voiding difficulties were less preferred.

Conclusions: This is the first DCE to investigate differential characteristics of surgical treatment options for UI and their potential impact on women’s decision to undergo surgery. Although women with a treatment history had a negative preference for surgical treatments, those with forms of UI that were reported to be extremely or moderately limiting in daily activities preferred the surgical treatment option to no surgery.

Relevance to patients and consumers: 

Our research provides insights into what women with and without UI want their treatment options to be like and which treatment characteristics they prefer. Previous research suggests that women underreport their condition and self-manage rather than seeking early treatment. Barriers to seeking professional help may be imposed by a lack of awareness of treatment options, perception that these symptoms are normal, or feelings of shame/embarrassment. Considering women’s preferences and trying to reduce those barriers may help in reducing levels of unmet need for incontinence services and in improving the organization of surgical services.