You must treat people, not bodies: Improving Shared Decision Making in Men with Benign Prostatic Hyperplasia

Abstract

Background: Benign Prostatic Hyperplasia (BPH) is a common urological condition where non-cancerous enlargement of the prostate can cause urinary symptoms that impact men’s physical, social, and psychological wellbeing. With no single best treatment option, a shared decision making (SDM) approach is required that accurately reflects individual’s preferences and needs. However, there is limited understanding of this process for BPH, including how healthcare professionals and existing interventions, called decision aids (DAs), support patient involvement.
Purpose: The current thesis sought to i) explore SDM provision within BPH care in the United Kingdom, and ii) develop a decision aid alongside public contributors, for use in practice that improves patient experience and supports treatment decision making.
Methods: Drawing on the Person-Based Approach (PBA) and Behaviour Change theories, the thesis utilises a mixed-methodology, underpinned by a pragmatist epistemology. Evidence across four empirical studies, including a systematic review, multi-site observations of practice, and stakeholder workshops and interviews are triangulated to create a theory-informed DA, OPTIMEN.
Findings: With limited connection to theory and a lack of focus on patient needs, many existing interventions are unable to facilitate patient-centred care. Observations highlighted wide variation in SDM practice across consultations, with a focus on clinical assessments, limited incorporation of patient preferences, and DAs underutilised. Stakeholders expressed they would use and recommend
OPTIMEN, viewing it as an educational and guiding resource, supportive of both informational and emotional needs of men and their families.
Conclusion: This thesis supports the utility of co-designed DAs and for OPTIMEN as a valuable patient-facing resource for navigating treatment for BPH. With an evolving treatment landscape and varied patient population, BPH represents a crucial area for SDM improvement. Targeted DAs like OPTIMEN, with the suggested refinements, have the potential to improve individuals understanding of BPH and their preferences, creating opportunities for greater collaboration and patient-centred care.

Date of Award	7 Jul 2026
Original language	English
Awarding Institution	University of Winchester
Supervisor	Margaret Husted (Supervisor), Debra Gray (Supervisor) & Richard Hindley (Supervisor)