In this step, opportunities can be provided to patients for addressing misinformation about their diseases and helping them realize unrealistic goals, because they might misunderstand their condition and have unreasonable or unrealistic goals for treatment. However, physicians should not modify or manipulate the goals. After the detailed conversation, patients decide their treatment goals. When patients have multiple goals, they need to rank the importance of the goals during the conversation. Goals
might be related to symptoms (e.g. frequency, urgency, or nocturnal), physical impact (e.g. ability to work, travel, or perform activities), emotion learn more (e.g. worry about leaking urine), sexual function (e.g. decrease in sexual desire), social relationships (e.g. embarrassment in public, avoidance of social activities), Romidepsin clinical trial coping strategies (e.g. wearing pad or changing underwear), or quality of life (e.g. sleep quality). The next step is to identify patient expectations for treatment benefit. Goals are typically stated in terms of lifestyle events that are
affected by the health problem. For example, a patient may say that his or her treatment goal is to “be able to sleep at night without going to the toilet”, or “travel without worry of going to the toilet”. However, patient expectations are generally stated in terms of symptom relief. Additionally, the expectations might include the entire treatment experience, including physician personality, waiting times, hospital facilities, and complications. As in setting goals, physician should Immune system not modify or manipulate patients’ expectations. The final step is to assess goal achievement after treatment. At that time, patients review their pretreatment goals and rate their perceptions of goal achievement compared with the initial expectations. This can be measured using
a visual analog scale or Likert scale. The efficacy of antimuscarinics has been demonstrated in the treatment of overactive bladder (OAB) through well-designed, randomized controlled trials; however, the clinical significance of these findings is in doubt.5–7 Poor compliance and persistence with medication suggest that many patients perceive little ongoing benefit and have unmet expectations from the treatment.8,9 One of the reasons for the discrepancy between investigational and clinical points of view is the lack of patient-driven criteria in outcome assessment. Thus, investigators who are working on outcome research have been testing patient-reported goal achievement in the treatment of OAB.10–12 Choo et al.10 first reported the efficacy of antimuscarinics in terms of goal achievement in OAB patients. After a 12-week treatment with tolterodine, the median rates of goal achievement for each OAB symptom were 60% for frequency, 60% for urgency episodes, and 80% for urgency incontinence compared with the initial expectation of symptom improvement.