Vesicoureteral reflux (VUR), a congenital condition in which urine backs up from the bladder into the kidneys, comes with a mix of treatment options, but picking one may come down to a matter of parental preference when these options have a similar risk-benefit balance. Often one treatment is not clearly better than another for a particular child. The condition frequently resolves on its own as children grow, but some youngsters experience recurrent urinary tract infections and risk kidney damage from VUR.
“There often is not a correct treatment choice, but rather a best choice, given a combination of clinical factors and parental preferences,” said pediatric urologist Hillary Copp, MD, MS. Current guidelines from the American Urological Association, which Copp helped write, state that parental preferences should be included when treatment choices offer a similar balance of risk and benefit.
Copp is heading a new study that seeks to develop a decision tool parents can use to help them determine their preferences. The approach is modeled from methods used in marketing research to measure preferences for product features. Dr. Copp is collaborating with researcher and prostate cancer specialist, Christopher Saigal, MD, MPH, at UCLA, and marketing specialist, Anand Bodapati, at the UCLA Anderson School of Management to develop a conjoint analysis tool, similar to that used to help men make decisions about prostate cancer treatment options.
Options for VUR treatment may include watchful waiting, often combined with prophylactic use of antibiotics to prevent infections. However, recent studies, including several by Dr. Copp, have shown that antibiotic prophylaxis is not always helpful in preventing UTIs, to some extent because many parents do not administer the drugs as prescribed. For children who experience regular infections despite prophylactic antibiotic use, urologists may perform either incision or no-incision surgery to prevent urine in the bladder from “backwashing” into the ureter.
“The best approach depends in part on how parents feel about the risks involved with these options, such as antibiotic resistance and surgical risk,” said Copp.
In this first phase of the study, they will conduct in-depth interviews with parents who have already chosen a management option to see what factors were important to them in their decision process. That information will be used to develop the analysis tool, which will then be tested with patients in a multicenter study. Eventually, the research team’s goal is to make the decision tool available to parents online.