OPTIMISE BPH
Research type
Research Study
Full title
OPTIMISE: Optimising Patients’ surgical Treatment Choices in Male Benign Prostatic Hyperplasia (BPH)
IRAS ID
329549
Contact name
Margaret Husted
Contact email
Sponsor organisation
University of Winchester
Clinicaltrials.gov Identifier
https://osf.io/378a2/, Open Science Framework Project Registration
Duration of Study in the UK
2 years, 0 months, days
Research summary
Summary of Research
Benign Prostatic Hyperplasia (BPH) is a common condition affecting adult males that causes urinary problems and erectile dysfunction. The condition has been shown to have significant impacts on quality of life. Men have often been managing the condition for many years by the time they see a hospital consultant. There are a range of surgical treatments offered across the UK, which vary based on outcome expectancy, level of surgical invasiveness, and side-effects. It is therefore important to ensure men are engaged with the decision-making process for their treatment for BPH, as this is known to influence both patient treatment outcomes and satisfaction. The OPTIMISE project aims to help address this issue. Specifically, this project will address what currently occurs within BPH consultations, how men are making surgical treatment choices for BPH, and what men perceive as a "good improvement" following BPH surgery. The research will be conducted in four urology services in NHS-England. The four sites have been chosen to ensure a breadth of clinical practice, surgical treatment options, and patient perspectives. This research has 3 phases: Phase 1: an observational study (looking at current clinical practice by observing BPH practice and consultations); Phase 2: a sorting task/interview study with BPH patients to see how men weigh up different risks and benefits from surgical options; Phase 3: an interview study with post-surgery BPH patients to understand what they regard as a good improvement. A research schematic (Research Schematic, document attached) has been developed to outline these studies. It is expected that the research will be undertaken within two years and the findings will contribute to the development of a decision aid and/or practice recommendations for use within future BPH surgical consultations.Summary of Results
Benign Prostatic Hyperplasia (BPH) is a non-cancerous health problem. It causes the prostate to increase in size, putting pressure on the systems in the body used for going to the toilet. Separate from Prostate Cancer, BPH affects around 3.2 million men in the UK. Problems going to the toilet but can be ignored or downplayed by men if they feel embarrassed, ashamed, or believe it is due to age. Men sometimes wait to get treatment until their symptoms seriously affect their everyday lives. Men have the choice between multiple treatment options but must think carefully about what is most important to them alongside the different risks and benefits. This research aimed to create a tool for practice that supports decision making for men with BPH and improves their experiences as patients. Information from nurse interviews, a review of interventions, observations of hospital appointments, and patient workshops identified key areas for improvement. These mostly focus on ensuring patient preferences are identified, listened to, and acted on when making care and treatment decisions.Existing interventions, called decision aids, were missing key information on what matters most to individuals, support for loved ones, and links to how people make decisions about their health. Workshops with patients and their partners revealed that more support was needed to get people to think about what they wanted out of treatment and how to compare their treatment options. Men were found to seek treatment when going to the toilet affected their sleep, work, travel, or everyday activities and sport. It is more common for men to say they have seen a "good" improvement after surgery if these factors are considered and targeted. Observations of 70 appointments across four hospitals showed differences in patient’s care and the information they received. Patients underwent different tests, with limited information on their purpose, and it was unclear if their goals for treatment were meaningfully considered. Most clinicians did offer information on different treatment options, with some using diagrams and drawings to explain them to patients. However, some clinicians focused on medical symptoms instead of what patient’s felt and wanted from their treatment. Feedback from our patient workshops led us to also speak to nurses about their involvement in this patient journey. Nurses play a supportive role in patient's hospital care and often see patients early on in their contact with the service. Nurses spoke about advocating for patient choice, whilst balancing the demands of a busy and changing hospital setting. However, more research is needed to explore the patient journey in hospital and nurse’s role in this. Decision aids were not always used in appointments, but staff described them as useful tools that could bridge gaps in patient's understanding of BPH and its treatments. When decision aids were used, more collaboration and patient involvement was observed.
Based on our research evidence we have then designed an online decision aid, working in collaboration with people with lived experience, called OPTIMEN. Our goal is that OPTIMEN will offer a simple, but effective, way to improve patient and clinician conversations and support treatment choices that consider patient priorities and goals. Interviews and surveys from men, their families/carers, and healthcare staff show good support for OPTIMEN, with most agreeing that they would use it themselves and recommend it to others. Participants agree that the decision aid provides support beyond initial decisions and for navigating ongoing care, as well as providing information and support for partners and family. We aim to improve OPTIMEN in the future with the help of more stakeholders such as community organisations and charities. This will also mean testing OPTIMEN in hospital settings, during or before appointments where treatment options for BPH are spoken about.
REC name
London - Chelsea Research Ethics Committee
REC reference
24/PR/0293
Date of REC Opinion
7 May 2024
REC opinion
Further Information Favourable Opinion