THE IMPACT OF URGE URINARY-INCONTINENCE ON QUALITY-OF-LIFE - IMPORTANCE OF PATIENTS PERSPECTIVE AND EXPLANATORY STYLE

OBJECTIVES: The impact of urinary incontinence (UI) on health-related quality of life (QoL) is significant yet variable, but little is known about patient-defined content areas regarding the influence of UI on QoL and whether patient-specific factors correlate with specific conte nt areas of UI-related QoL. In order to identify the most valid conten t areas for a new UI-related QoL questionnaire, our primary goal was t o determine the content areas of greatest concern regarding UI-related QoL among older persons with urge incontinence. The second goal was t o examine the possible role of patients' explanatory style as a mediat or of UI impact on health-related QoL. Data on the questionnaire will be presented elsewhere. DESIGN: Focus groups comprising urge-incontine nt persons were used to obtain verbatim descriptions of the impact of UI on QoL. SETTING: A university-affiliated tertiary hospital. PARTICI PANTS: Community-dwelling women (n = 25) and men (n = 5) more than 60 years of age, with urge incontinence, recruited from newspaper, newsle tter, and radio advertisements. MEASUREMENTS: Qualitative content anal ysis of focus group transcripts was used to determine QoL items. These were compared with previously described UI-related QoL items obtained from the literature. Subjects' statements regarding causes of UI were evaluated for predominant explanatory style. RESULTS: Thirty-two UI-r elated QoL items were identified, more than half of which were not des cribed previously. Compared with expert-defined UI-related QoL items f rom the literature, patient-defined items focused more on coping with embarrassment and interference from UI than on prevention of actual ac tivity performance. Explanatory statements were made frequently by pat ients talking about their UI. Although positive style explanatory stat ements were most common, they did not correlate with any QoL items. By contrast, there was a significant correlation between negative explan atory style and six specific UI-related QoL items. CONCLUSIONS: Focus groups of older persons with urge incontinence suggest that experts an d patients view the impact of urge UI on QoL differently. Whereas expe rts focus more on functional impact, patients more often cite the impa ct of UI on their emotional well-being and on the interruption of acti vities. In addition, the association between negative explanatory styl e and specific UI-related QoL items suggests that explanatory style ma y be an important mediator of patients' perceptions of UI-related QoL.