Gaps in patient-reported outcome measures integration into the management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH): qualitative insights for implementation strategies.

Abstract

Background: Patient-reported outcome measures (PROMs) are commonly used to monitor lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH). However, there is limited evidence on patients' perspectives on integrating PROMs into clinical practice and on best practices to improve their implementation to better meet patient needs. The aim of this study is to explore patients' experiences completing PROMs during routine BPH management, and to develop patient-informed strategies for PROM implementation in urologic care.

Methodology: Virtual semi-structured telephone interviews were conducted with English-speaking patients aged 50 years or older with BPH who attended outpatient urology clinics between May and October 2025. Patients were purposively sampled based on the type of treatment received (medical or surgical). Interview data were analyzed using interpretive description. Themes were synthesized inductively, and practical implementation strategies were developed from participants' suggestions.

Results: Twenty patients participated (12 received medical treatment and 8 received surgical treatment). Four themes emerged regarding patient perspectives on PROM use in routine care: (1) Perceived benefits-patients viewed PROMs as valuable tools for tracking symptom progression, prompting self-reflection, and facilitating communication among the clinical care team; (2) Questionnaire content-patients questioned the relevance of specific domains, particularly the non-specificity of the PROMIS pain scales as well as mental health, and sexual health items; (3) Perceived barriers-participants criticized the excessive volume of questionnaires; and (4) Considerations for PROM Integration-participants emphasized the importance of visible follow-up actions based on PROM results. Practical recommendations for PROM integration in routine clinical practice included: (1) enhancing patient understanding of PROMs by providing a brief rationale prior to survey administration; (2) implementing a patient-preference PROM workflow in the electronic health record (EHR); and (3) providing tangible actions based on PROM results, such as summarizing scores in plain language and incorporating results into discussions during visits.

Conclusions: This study provides patient-informed insights into the implementation of a broad PROM battery in LUTS/BPH care. Participants emphasized that PROMs are more acceptable when their purpose is clearly explained and when responses are visibly discussed or acted upon in care. Future research should examine how these patient-informed strategies can be operationalized within clinical workflows and integrated with clinician, administrator, and EHR perspectives to support sustainable PROM use in routine practice.