title: Ensuring comprehensive assessment of urinary problems in prostate cancer through patient-physician concordance.
abstract: OBJECTIVE
  To examine the concordance between clinicians and men diagnosed with prostate cancer on a clinician-derived pathophysiological classification of the following self-reported urinary complications: storage (irritative), voiding (obstructive), and leakage/incontinence.
  
  
  METHODS
  Fourteen urology experts classified 37 urinary function questionnaire items into 3 primary conceptual dimensions (e.g., storage [irritative], voiding [obstructive] and urinary leakage/incontinence) that would best reflect each item's content. In addition, 218 patient participants provided responses to the 37 items. Using classifications by experts to develop the conceptual framework, the structure was tested using confirmatory factor analyses with patient data.
  
  
  RESULTS
  Expert consensus was achieved in the classification of 31 out of 37 items. Using the 3-factor conceptual framework and patient data, the fit indices for the overall correlated factor model suggested an acceptable overall model fit. The analyses of the separate domains showed acceptable fit for the storage/irritative domain and the leaking/incontinence domain. The dimensionality of the voiding/obstructive domain was too difficult to estimate.
  
  
  CONCLUSIONS
  Our analysis found items that conceptually and psychometrically support 2 constructs (leaking/incontinence and storage/irritative). The consistency of this support between the groups suggests a clinical relevance that is useful in treating patients. We have conceptual support for a third hypothesis (voiding/obstructive), although there were too few items to assess this psychometrically. Relative motivating factors of bother and urinary complaints were not addressed and remain an unmet need in this field.
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, IL. Electronic address: d-victorson@northwestern.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Victorson
authors.affiliation: Brucker and Associates, Naperville, IL.
authors.forename: Penny S
authors.initials: PS
authors.lastname: Brucker
authors.affiliation: Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, IL.
authors.forename: Rita K
authors.initials: RK
authors.lastname: Bode
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, MN.
authors.forename: David T
authors.initials: DT
authors.lastname: Eton
authors.affiliation: Center for Outcomes Research, Massachusetts General Hospital, MA.
authors.forename: James A
authors.initials: JA
authors.lastname: Talcott
authors.affiliation: Boston University School of Public Health and Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, MA.
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.affiliation: Department of Psychiatry, University of California San Francisco, CA; Department of Urology, University of California San Francisco, CA.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Knight
authors.affiliation: Department of Urology, University of California Los Angeles, CA; Department of Health Services, University of California Los Angeles, CA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.affiliation: Fred Hutchinson Cancer Research Center, WA.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Moinpour
authors.affiliation: Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC.
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.affiliation: Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, The Netherlands.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, SC.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center and Weill-Cornell Medical College, NY.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
authors.affiliation: Department of Surgery, NorthShore University Health System, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: McGuire
authors.affiliation: Division of Hematology/Oncology, NorthShore University Health System, IL.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shevrin
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, IL.
authors.forename: Kevin
authors.initials: K
authors.lastname: McVary
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, IL.
authors.forename: David
authors.initials: D
authors.lastname: Cella
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000150:complications* / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000209:etiology*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology*; D014555:Urination Disorders / Q000175:diagnosis / Q000209:etiology*; D014572:Urology / Q000592:standards
keywords: Health-related quality of life; Patient-reported outcomes; Prostate cancer; Storage (irritative) symptoms; Urinary incontinence; Voiding (obstructive) symptoms