Assessment Of The Performance Of The American Urological Association Symptom Score In 2 Distinct Patient Populations

January 25, 2009 at 8:00 am Leave a comment – Society, families, and individuals place trust in physicians to care for the sick. Intrinsic in this trust is the understanding that physicians’ decisions will always be in the best interest of the patients, that physicians will ‘do no harm.’ Given the high cost of error, physicians therefore spend a significant amount of clinical time communicating with patients. However, financial and political constraints increasingly limit the time a physician can spend with a patient and his or her family, significantly threatening this ability to communicate accurately. Consequently, physicians increasingly use written tools to screen patients for disease, stratify their symptom severity for treatment, or follow their symptom progression.

One such tool is the AUA symptom score (AUS-SS), which is often known as the International Prostate Symptom Score (IPSS), the most commonly used tool worldwide to assess BPH. We previously studied the ability of 300 patients to understand the AUA-SS. In this population of indigent patients, only 16% fully understood the AUA-SS. More ominously, 60% of our patients claimed to fully understand the questionnaire, while they did not. However, we anecdotally noticed that confusion and inaccuracies associated with the AUA-SS were not isolated to this indigent population. Therefore, we attempted to expand this original study to include more affluent patients at a university hospital setting.

In this current study, we interviewed 407 patients at two sites of service, a university and county hospital. Contrary to our previous findings, 72% of patients across all sites understood the entire AUA-SS. At first glance, public hospital patients, who averaged approximately 4 fewer years of education, had lower rates of understanding compared to university patients. Compared to 26% of county patients, only 3% of university patients understood less than half of the AUA-SS’s 7 questions. However, univariate and multivariate analyses revealed that neither location nor socioeconomic status were significant drivers of this misunderstanding. Instead, the only significant risk factor for misunderstanding the AUA-SS was education level. The average public hospital patient’s lower education level explained the poorer performance of the AUA-SS. However, this did not prevent university hospital patients from misunderstanding the AUA-SS. A definitive number of these patients, with higher incomes and better insurance, also misunderstood the AUA-SS.

The AUA-SS has been demonstrated time and again to be a significant and helpful tool in the diagnosis, treatment, and management of BPH. However, as with any tool, its use also brings risk. It is incumbent upon clinicians to (at least initially) assess their patient’s understanding of the AUA-SS, in order to prevent miscommunication and subsequent harmful mismanagement of disease.

Written by Viraj Master, MD and Tim Johnson, MD as part of Beyond the Abstract on

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