Background <p>Refractory overactive bladder (OAB) lacks formal definition and is poorly understood. Its management requires patients to choose an invasive treatment, including intravesical botulinum toxin A (BOTOX®), sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS), which have varying rates of efficacy and side effects. These decisions can be complex for patients to make, especially within the time constraints of outpatient clinic appointments. A new patient decision aid (PDA) has been developed to support patients during this shared decision-making process.</p> Aim <p>This study assesses decisional conflict scores and patient satisfaction in those who use a novel PDA for refractory OAB.</p> Methods <p>Consecutive new patients with refractory OAB were provided with the PDA prior to decision-making. Patients then had a virtual follow-up appointment to assess their decisional conflict, using a validated scale. The total decisional conflict score was calculated. Treatment choice and free-text feedback were also analysed.</p> Results <p>Twenty-five patients were included. Following use of the PDA, a range of treatment choices were made, including SNM (<i>n</i> = 6), PTNS (<i>n</i> = 10), BOTOX® (<i>n</i> = 6) and continuation with medical therapy (<i>n</i> = 3). Overall, decisional conflict was low, with 100% of patients having a score of less than 25. Subscores suggested improved patient understanding, with the PDA increasing clarification.</p> Conclusion <p>Introduction of this novel PDA, in those requiring treatment for refractory OAB, was associated with low decisional conflict and positive patient feedback. This supports its use in shared decision-making, empowering patients to make an informed and individualised choice regarding their treatment.</p>