Impact of Decision Aids in Urogynecology

To evaluate how patient knowledge and confidence in decision making can be impacted by shared decision making in common urogynecology conditions.

The investigators will enroll patients seeing a specialist to discuss treatment of pelvic organ prolapse, overactive bladder and stress urinary incontinence in this pilot study. The study will evaluate the feasibility and acceptability of three decision aids designed to promote shared decision making conversations for these three condition. The investigators use a quasi-experimental design in which the investigators first enroll patients in the control arm and measure their outcomes. Then, the investigators enroll patients into the intervention arm and measure their outcomes. The investigators estimate that it will take about one month to recruit the control arm and one month to recruit the intervention arm. Patients will be surveyed after the clinic visit with a specialist and surveys will assess patients' knowledge, treatment preferences, shared decision making, decisional conflict and acceptability of the tool. A clinician survey will be administered and completed after each patient visit, that details how the physician felt about the length of the visit, how informed the patient was, and how far along they may be with their decision.

Paper-based educational tool to guide shared decision making conversations for treatment of pelvic organ prolapse

Paper-based educational tool to guide shared decision making conversations for treatment of stress urinary incontinence.

Paper-based educational tool to guide shared decision making conversations for treatment of overactive bladder.

Patients completed four multiple choice knowledge items for each condition and a total knowledge score (0-4) was created with higher scores indicating higher knowledge.

1 item assess patients' preferred treatment- Response options included no treatment at this time, conservative and none conservative options, or I am not sure.

Physicians answered 1 item on their perception of the impact of the decision aid with response options: Extremely satisfied, Very satisfied, Somewhat satisfied, and Not at all satisfied

Four item version of decisional conflict scale. Total scores range from 0-4 with higher scores are better.

Three items ask patients to rate their provider on a scale of 1-10, with 10 being outstanding. Reported as the percent who give the top score.

One item assessed how physician felt about the length of the visit. Responses were: Shorter than normal, About normal, Longer than normal.

Recruiting only female patients as Urogynecology conditions only affect women's pelvic organs and pelvic floor.

Inclusion Criteria: Adults 18-95 years only English speaking Pelvic organ prolapse defined by noticeable (to the patient) vaginal bulging Symptoms of stress urinary incontinence (cough, sneeze, laugh, exercise) Presenting for initial consultation for either of the above symptoms Exclusion Criteria: Primary complaint is not vaginal bulging or stress urinary incontinence Prior surgery for pelvic organ prolapse or any incontinence procedure

Marques F, Josloff K, Hung K, Wakamatsu M, Sepucha KR. Decision aids and shared decision making in urogynecology. Menopause. 2021 Dec 13;29(2):178-183. doi: 10.1097/GME.0000000000001901.