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Table 1 Characteristics of the studies retrieved

From: Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients’ care – a systematic review

Study and year

Design

Main findings

ACCF 2012 [40]

Guidelines

Patient centered approach should be implemented in the management of the cardiological patient.

Agarwal 2014 [25]

Observational

Patient perception of urinary incontinence may differe from clinicians perception.

Balint 1969 [33]

Lecture

A shift of emphasis in the research from expecting the doctor to be a sort of detective inspector to a study of the varieties of response open to the doctor; or to put it in other words to the variety of ways the doctor can be used. This may be one of the changes which will lead to understand the possibilities and techniques of ‘patient-centred medicine’ and thus to undo the split in the doctor.

Bertaccini 2001 [29]

Observational

Quality of life is a major determinant in LUTS/BPH patients evaluated by the ICS-Qol questionnaire.

Cindolo 2014 [20]

Observational

Adherence to pharmacological therapy for BPH is low and could affect clinical outcomes. Our findings suggest the need for new strategies to increase patient adherence to prescribed treatment and more appropriate prescribing by physicians.

Cindolo 2015 [21]

Retrospective

Adherence to pharmacological therapy of BPH-associated LUTS is low and varies depending on drugs class. Patients under CT have a higher likelihood of discontinuing treatment for a number of reasons that should be better investigated. The study suggests that new strategies aiming to increase patient’s adherence to the prescribed treatment are necessary in order to prevent BPH progression.

Cornu 2010 [8]

Review

Major variations were seen among European countries concerning the prescriptions related to BPH, although the prevalence of the disease and the guidelines are similar. Analysis of actual prescription levels would complement evidence-based medicine as critical material for public health analysis, recommendations, and health insurance policies.

Coyne 2009 [31]

Observational

In this large population study of three countries, LUTS are highly prevalent among men and women aged > 40 years. In general, LUTS experienced ‘often’ or more are bothersome to most people.

Chung 2013 [27]

Prospective

LUTS are important risk factors in predicting the presence of clinically relevant depressive symptoms. In elderly men, increased awareness and possible screening are needed to detect the increased risk of clinically relevant depressive symptoms.

De Nunzio 2016 [7]

Review

The possibility of tailoring BPH treatment according to different patient characteristics and expectations, using two or more drugs, seems a promising path in the field of LUTS/BPH management; however, physicians should consider the risk of increasing costs without proven long-term efficacy with most of these combination treatments.

Epstein 2005 [24]

Rieview

PCC is regarded by the public, health care organizations, funding agencies and licensure bodies as a component of high-quality care. Defining outcomes of patient centeredness is essential to measure the clinical impact of a PCC approach.

Foo 2010 [9]

Review

The final decision for management of LUTS/BPH patient can then be tailored and individualized to achieve cost-effectiveness

Emberton 2007 [23]

Observational

This study highlights discrepancies between views and beliefs of patients and physicians regarding BPH and current practice in Europe.

Emberton 2010 [24]

Review

Improved physician–patient communication will help determine the best treatment option for patients with BPH and may ensure greater compliance and treatment success.

Foo 2017 [10]

Review

Treatment of prostatic adenoma can be individualized and tailored. Final decision-making would be personalized to the patient’s age, comorbidity and preferences (values). This would be in line with the recent emphasis on patient-centered care in evidence-balanced medicine, treating the patient not just the disease.

Fourcade 2008 [11]

Observational

There were geographical discrepancies that could be attributed to either different cultural habits or merely organisational differences, e.g. the presence of office urologists in Germany or diverse modes of access to phytotherapy (prescription vs ‘over the counter’) in the various countries.

Fourcade 2012 [12]

Observational

Around half of BPH patients medically treated report unsatisfactory outcomes, suggesting consequential unmet medical needs in general practice. A patient centered approach may improve outcomes.

Garraway 1993 [28]

Observational

Further investigation of these possible influences on non-consultation is required before any programme of health education can be considered which would encourage a higher proportion of men with bothersome urinary symptoms to come forward for attention at an earlier stage in the natural history of benign prostatic hyperplasia.

Greenhald 2014 [35]

Essay

Evidence based medicine has not resolved the problem sit set out to address (especially evidence biases and the hidden hand of vested interests),which have become subtler and harder to detect. Despite lip service to shared decision making, patients can be left confused and even tyrannised when their clinical management is inappropriately driven by algorithmic protocols,top-down directives and population targets.

Hong 2005 [5]

Review

Patient perceptions are receiving greater emphasis as part of clinical decision-making. Selecting an inappropriate treatment, or not including the patient’s preference, may lead to a cascade of therapies and unmet expectations, and increase the economic and human burden of the disease.

Hollingsworth 2009 [13]

Retrospective

On average, urologists had a higher intensity practice style for benign prostatic hyperplasia than primary care physicians. Further studies are needed to determine how these practice style differences relate to patient clinical outcomes.

Lamiani 2008 [37]

Prospective

Results suggest that the concept and practice of patient-centred care is variable and may be influenced by culture. The study methodology improved participants’ self-awareness of cultural values, and has potential as a cost-effective, experiential educational approach

Little 2001 [1]

Observational

Components of patients’perceptions can be measured reliably and predict different outcomes.If doctors don’t provide a positive,patient centred approach patients will be less satisfied,less enabled,and may have greater symptom burden and higher rates of referral.

Makoul 2001 [17]

Review

The group identified seven essential sets of communication tasks: (1) build the doctor-patient relationship; (2) open the discussion; (3) gather information; (4) understand the patient’s perspective; (5) share information; (6) reach agreement on problems and plans; and (7) provide closure. These broadly supported elements provide a useful framework for communication-oriented curricula and standards

Miner 2009 [15]

Review

General Practitioners and Urologist manage LUTS/BPH patients differently and not always according to the guidelines. Increasing communication between patients, GPs and Urologist may improve management of LUTS/BPH patients.

Mozes 1999 [26]

Observational

The relative weight of the impact of a symptom or disease on QoL domains is changed by the presence of other competingfactors, such as co-morbidities or sociodemographic attributes. Social context and quality of life is essential for a correct management of LUTS/BPH patients

Murray 2001 [3]

RCT

An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and let patients play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.

Piercy 1999 [46]

Observational

A shared decision making program is beneficial for the patient and should be implemented in clinical practice specially for LUTS/BPH patients. Patients were enthusiastic and physician-patient relationship could be enhanced.

Ridder 2015 [30]

Observational

The prevalence of LUTS, especially nocturia and urgency, is high and a significant number of men indicated to be seriously bothered. Increasing awareness of male LUTS, and storage symptoms in particular, is warranted to discuss management options that could increase quality of life.

Sells 2000 [32]

Prospective

The study confirmed the presence of significant morbidity in the partners of patients with BPE. The degree of partnermorbidity was related to the severity of the patients’ symptoms. Including the social entourage when managing LUTS/BPH patient may improve its management.

Stewart 2001 [34]

Editorial

Patients “may not prefer a patient centred approach” and hence its universal adoption would be “unwise.” Patient centred clinical practice is a holistic concept in which components interact and unite in a unique way in each patient doctor encounter.

Wei 2011 [14]

Observational

Significant differences in practice patterns were observed between primary care physicians and urologists in the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia. These data establish valuable benchmarks and identify possible interventions that may improve the standard of care.

Wagg 2012 [19]

Observational

Need for a better understanding of non-persistent patients treated with antimuscarinics and for the development of initiatives to improve the quality of drug therapy management. Further studies are required to investigate the reasons underlying this trend, such as lack of effi cacy, poor tolerability or inconvenient dosing, why patients are lost to follow-up, whether symptoms resolve at some point during the prescribed treatment, and whether lack of patient understanding about the need for long-term management is a factor.

Weston 2001 [22]

Comment

When you and your patient disagreeabout management, be sure to listen carefully to thepatient’s ideas and paraphrase them so that the patient knows that you understand his or her point of view. Then, express your concerns and engage in a discussion that seeks to find common ground.

WHO 2003 [16]

Review

Methods and interventions to improve drug adeherence.