Patients’ and healthcare professionals’ experiences and views of recurrent urinary tract infections in women: qualitative evidence synthesis and meta-ethnography

Sanyaolu, Leigh N. ORCID: https://orcid.org/0000-0002-6762-6986, Hayes, Catherine V., Lecky, Donna M., Ahmed, Haroon ORCID: https://orcid.org/0000-0002-0634-8548, Cannings-John, Rebecca ORCID: https://orcid.org/0000-0001-5235-6517, Weightman, Alison ORCID: https://orcid.org/0000-0001-5210-3798, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446 and Wood, Fiona ORCID: https://orcid.org/0000-0001-7397-4074 2023. Patients’ and healthcare professionals’ experiences and views of recurrent urinary tract infections in women: qualitative evidence synthesis and meta-ethnography. Antibiotics 12 (3) , 434. 10.3390/antibiotics12030434

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Abstract

Background: Urinary tract infections (UTIs) are a common and significant problem for patients, clinicians, and healthcare services. Recurrent UTIs (rUTIs) are common, with a 3% prevalence in the UK. Although acute UTIs have a significant negative impact on the lives of patients, evidence of the impact of rUTIs is limited. To enhance shared decision-making around rUTI management, it is important to understand both the patients’ and healthcare professionals’ (HCPs’) perspectives. The objective of this qualitative evidence synthesis is to understand patients’ and HCPs’ experiences and views in the management of rUTIs. Methods: A qualitative evidence synthesis (QES) was performed that included primary qualitative studies involving patients with rUTIs or primary care HCPs who manage patients with rUTIs, up to June 2022. The following databases were searched: MEDLINE, Embase, CINAHL, PsycInfo, ASSIA, Web of Science, Cochrane Database of Systematic Reviews, Epistemonikos, Cochrane Central Registry of Controlled Trials, OpenGrey, and the Health Management Information Consortium (HMIC). The QES was prospectively registered on PROSPERO (CRD42022295662). Reciprocal translation was conducted and developed into a line of argument synthesis. We appraised the confidence in our review findings by using GRADE-CERQual. Results: Twelve studies were included in the final review; ten of those included patients, and three included HCPs (one study included both). Our review demonstrates that women with rUTIs have a unique experience, but it is generally of a chronic condition with significant impacts on numerous aspects of their lives. Antibiotics can be “transformative”, but patients have serious concerns about their use and feel non-antibiotic options need further research and discussion. HCPs share similar views about the impacts of rUTIs and concerns about antibiotic use and find the management of rUTIs to be complex and challenging. Based on our GRADE-CERQual assessment of the review findings, we have moderate confidence in those related to patients and low confidence in those related to HCPs. New conceptual models for both patients and HCPs are presented. Conclusions: This review has significant clinical implications. Patients require information on antibiotic alternative acute and preventative treatments for rUTIs, and this is not currently being addressed. There are communication gaps around the impact of rUTIs on patients, their perceived expectation for antibiotics, and the reasons for treatment failure. Further development of current clinical guidance and a patient decision aid would help address these issues.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Academic & Student Support Service Centre for Trials Research (CNTRR)
Publisher:	MDPI
ISSN:	2079-6382
Funders:	Welsh Government through Health and Care Research Wales (nihr-fs-2021-ls)
Date of First Compliant Deposit:	6 March 2023
Date of Acceptance:	20 February 2023
Last Modified:	03 May 2023 20:36
URI:	https://orca.cardiff.ac.uk/id/eprint/157533

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