Patient decision aids for pelvic floor surgery and impact on decisional conflict

Objectives

To evaluate whether the use of a patient decision aid (PDA) diminishes decision conflict in patients considering surgical treatment for stress urinary incontinence (SUI) or pelvic organ prolapse (POP) and to assess patient satisfaction concerning the PDA's user-friendliness and overall utility.

Design

One hundred women attending routine urogynaecology clinic appointments were offered the PDA as part of standard care and recruited into the study. After using the PDA, participants completed a decisional conflict scale (DCS) to assess their decision-making experience.

Setting

Single-site NHS tertiary-level care hospital outpatient department.

Population and Sample

The study included women considering surgical management for uterine/vault prolapse or SUI. Exclusion criteria comprised individuals under 18 years of age, those unable to communicate in English and patients not eligible for all surgical options presented in the PDAs.

Methods

Patients presenting to the urogynaecology clinic with symptomatic SUI or POP considering surgical treatment were invited to participate in the study. After using the PDA and at their next clinic visit, participants completed a DCS to assess their decision-making experience.

Main Outcome Measure

The DCS assessed the level of uncertainty and difficulty participants experienced in deciding on surgical treatment after using the PDA. A DCS score of less than 25 was associated with certainty in implementing the decision.

Results

This was a prospective cohort study of 100 participants. The DCS scores for the cohorts showed low decisional conflict, with median scores of 0.8 (IQR 4.7) for the vault PDA, 6.3 (IQR 25) for the uterine PDA and 7.8 (IQR 21.1) for the SUI PDA. A sub-score analysis revealed higher scores for ‘uncertainty’ and ‘effective decision making’ in 21 participants with total DCS scores above 25.

Conclusion

NICE PDAs are valuable tools for enhancing decision-making in gynaecological surgery. However, this study highlights the need for their ongoing refinement to better address the informational and emotional aspects of patient decision-making. Future research should focus on incorporating emotional support frameworks and psychological management tools to improve their clinical utility and effectiveness.