Patients’ experiences and views of recurrent urinary tract infections: qualitative evidence synthesis and meta-ethnography.

Problem

Urinary tract infections (UTIs) are common and result in significant morbidity, negative impacts on daily life, reduced quality of life and reduced work attendance. Recurrence is common and recurrent UTIs have an estimated annual prevalence of 3%. The experience of women with recurrent UTIs is not well understood and is likely to be different to those without recurrent UTIs. To enhance shared decision-making around recurrent UTI management it is important to understand patients’ experiences and perspectives.This qualitative evidence synthesis aims to understand the experiences of women with recurrent UTIs.

Approach

A qualitative evidence synthesis was performed that included primary qualitative studies involving patients with recurrent UTI. We systematically searched MEDLINE, Embase, CINAHL, PsychInfo, ASSIA, Web of Science and the grey literature from inception to June 2022. Meta-ethnography was conducted to synthesise the studies using reciprocal translation and a line of argument synthesis. A conceptual model was then developed. The ‘Confidence in the Evidence from Reviews of Qualitative research’ (GRADE-CERQual) approach was used to appraise the confidence in the review findings.

Findings

Ten primary qualitative studies published from 2005 to 2022 and conducted in Europe and the USA were included. Studies involved patients from primary care, secondary care outpatients or online postings.We had moderate confidence in the seven review findings based on the GRADE-CERQual assessment. Our review demonstrates that women with recurrent UTIs have a unique experience but it is generally of a chronic condition with significant impacts on numerous aspects of their lives. Several factors are described as triggers for recurrent UTIs and patients commonly use self-help, lifestyle measures and complementary and alternative medicine to try and manage their recurrent UTIs. Antibiotics can be ‘transformative’, but patients have serious concerns about their use and feel non-antibiotic options need further research and discussion. Patients seek healthcare for most but not all UTI recurrences and are frustrated with healthcare in terms of antibiotic use and an underestimation of the impact of recurrent UTIs.

Consequences

This is the first qualitative evidence synthesis on the experiences of women with recurrent UTIs and has significant clinical implications. Patients require information on antibiotic alternative acute and preventative treatments for recurrent UTI and this is not currently being addressed. There are communication gaps around the impact of recurrent UTI on patients. Further research and development of a patient decision aid could help address some of these issues.