Factors associated with a positive experience at US fertility clinics: the male partner perspective.

OBJECTIVE: To determine factors associated with a positive male patient experience (PMPE) at fertility clinics among male patients. DESIGN: Cross-sectional study Setting: Not applicable Patients: Male respondents to the FertilityIQ questionnaire ( www.fertilityiq.com ) reviewing the first or only US clinic visited between June 2015 and August 2020. INTERVENTIONS: None Main outcome measures: PMPE was defined as a score of 9 or 10 out of 10 to the question, "Would you recommend this fertility clinic to a best friend?". Examined predictors included demographics, payment details, infertility diagnoses, treatment, and outcomes, physician traits, and clinic operations and resources. Multiple imputation was used for missing variables and logistic regression was used to calculate adjusted odds ratios (aORs) for factors associated with PMPE. RESULTS: Of the 657 men included, 60.9% reported a PMPE. Men who felt their doctor was trustworthy (aOR 5.01, 95% CI 0.97-25.93), set realistic expectations (aOR 2.73, 95% CI 1.10-6.80), and was responsive to setbacks (aOR 2.43, 95% CI 1.14-5.18) were more likely to report PMPE. Those who achieved pregnancy after treatment were more likely to report PMPE; however, this was no longer significant on multivariate analysis (aOR 1.30, 95% CI 0.68-2.47). Clinic-related factors, including ease of scheduling appointments (aOR 4.03, 95% CI 1.63-9.97) and availability of same-day appointments (aOR 4.93, 95% CI 1.75-13.86), were associated with PMPE on both univariate and multivariate analysis. LGBTQ respondents were more likely to report PMPE, whereas men with a college degree or higher were less likely to report PMPE; however, sexual orientation (aOR 3.09, 95% CI 0.86-11.06) and higher educational level (aOR 0.54, 95% CI 0.30-1.10) were not associated with PMPE on multivariate analysis. CONCLUSION: Physician characteristics and clinic characteristics indicative of well-run administration were the most highly predictive of PMPE. By identifying factors that are associated with a PMPE, clinics may be able to optimize the patient experience and improve the quality of infertility care that they provide for both men and women.

Palliative care use among bladder cancer patients treated with radical cystectomy.

INTRODUCTION: Practice guidelines recommend early consideration for palliative care for patients with advanced malignancies, and there has been limited research regarding the use of palliative care for patients with advanced bladder cancer. Our aim is to describe the rate and determinants of the use of palliative care consultation for patients treated with radical cystectomy at our institution. METHODS: A retrospective review was performed to identify patients who underwent cystectomy for bladder cancer between September 2014 and June 2019 at our institution. Our primary outcome was receipt of palliative care, defined as receiving a palliative care consult. We tested for associations between factors and our outcome of interest, and then estimated the impact on various determinants of palliative care use by fitting a multivariable logistic regression model. RESULTS: Over the study period, 294 patients underwent radical cystectomy. Of those patients, 29 (9.9%) received palliative care. Mean time from surgery to palliative care consult was 11.4 months. Palliative care consults were initiated by urologists in 32.1% of cases. On multivariable analysis, patients were more likely to receive palliative care if they had pT3+ disease (P < 0.001), were readmitted after surgery (P = 0.028), or had any major complication after surgery (P = 0.025). CONCLUSION: Rates of palliative care consults in patients with advanced bladder cancer at our institution are higher than other population-based estimates nationally. The majority of palliative care consults were requested by medical oncologists, highlighting an opportunity for educational initiatives for urologic oncologists to promote earlier consideration of palliative care referrals.

Testosterone Replacement-Freedom From Symptoms or Hormonal Shackles?

INTRODUCTION: The question of whether to initiate men on testosterone replacement therapy (TRT) and for how long remains a relevant question to be answered. AIM: To determine when to start patients on TRT, determine the benefits of TRT, and whether starting patients on TRT condemns them to a lifetime of hormonal replacement. METHODS: A literature review of relevant publications in PubMed was used. MAIN OUTCOME MEASURES: Main outcome measures were evidence for initiating TRT, benefits of TRT, pathophysiology of TRT, and evidence for duration of TRT. RESULTS: Although the exact threshold of serum testosterone levels that define hypogonadism is still strongly debated, the presence of symptoms associated with low levels of testosterone can be considered to help make the diagnosis. Although the proper duration of TRT has yet to be established, maintenance of symptom improvement after discontinuing TRT has been observed, which is a promising result. Studies also have shown a return to hormonal baseline after discontinuation of TRT. CONCLUSION: It has been established that patients with testosterone deficiency benefit from TRT. Preliminary evidence seems to show that men who are initiated on TRT are not condemned to a lifetime of hormonal therapy, although many men might choose to continue treatment because of improvement in their symptoms.