Self-management of male urinary symptoms: qualitative findings from a primary care trial

Informed self-management is the first-line treatment for male lower urinary tract symptoms (LUTS), although the extent of delivery in primary care is unclear. The TReating Urinary symptoms in Men in Primary Health care (TRIUMPH) cluster randomised controlled trial (reference: ISRCTN11669964) compared a structured self-management intervention with usual care for men with LUTS. We report on embedded qualitative interviews.

To investigate men's experiences of LUTS, engagement with primary care, and responses to a self-management intervention, along with the perspectives of primary care clinicians in order to inform the delivery of self-management guidance in primary care.

Qualitative interview study embedded in the TRIUMPH trial, which was conducted across 30 general practice sites in the South West of England.

Semi-structured interviews were conducted with 58 men with LUTS (selected purposively from the TRIUMPH trial population) and 14 treating clinicians (recruited from the TRIUMPH trial primary care sites), then analysed using thematic analysis.

Men with LUTS were characterised as 'languishing', poorly informed, discounting symptoms as 'just old men's problems', and experiencing prostate-specific antigen (PSA) testing cycles that did not resolve their LUTS. GPs described a focus on LUTS self-management being restricted by clinical pressures and attending to prostate cancer concerns. The TRIUMPH self-help intervention booklet was strongly valued by men: many reported that it gave them a greater understanding of their symptoms and self-management options, reduced anxiety, and that using it improved their LUTS and quality of life. A few men, however, found the intervention unrewarding.

Explanations and tailored self-management support were liked and found useful by many men with LUTS. Recommendations for clinical practice include: avoiding the expression 'old men's problems', ensuring LUTS follow-up after PSA testing, focusing on symptoms and self-management approaches, and distributing the TRIUMPH booklet widely.