Patient Decision Aids for Women With Urinary Incontinence: A Systematic Review.

Abstract

Importance: Across the urinary incontinence (UI) care continuum, women face multiple decision points from seeking an evaluation to selecting and pursuing treatment. Patient decision aids (PDAs) may facilitate decision making for UI care.

Objective: The objective was to evaluate the availability, effectiveness, and quality of PDAs for women with UI.

Study design: A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Central were searched from 2005, when the International Patient Decision Aid Standards (IPDAS) framework was introduced and the International Continence Society released updated UI definitions, through February 2026. Eligible studies evaluated PDAs for stress, urgency, or mixed UI. Primary outcomes followed the IPDAS framework and included attributes of the decision-making process, attributes of the choice, and health service outcomes.

Results: Of 3,737 records screened, 9 studies met criteria, included 956 women (mean age 48-69 years). All PDAs focused on treatment selection in specialty care; none addressed care-seeking decisions or care occurred in primary care. Although these PDAs were associated with reduced decisional conflict, evidence for improved knowledge, patient-clinician communication, or satisfaction was lacking. Despite 8 of 9 studies meeting more than half of the IPDAS criteria, the overall risk of bias was high due to nonrandomized designs.

Conclusions: Existing PDAs for women with UI focus on reducing uncertainty about treatment selection in specialty care, yet do not show a causal effect of PDA reducing decision conflict or address the foundational decision of whether to seek care. Future PDA development should span the full care continuum and ensure rigorous evaluation.