12: Decision aid video for treatment selection in Latina patients with symptomatic pelvic organ prolapse: A pilot study

Abstract

To assess impact of a decision aid video (DAV) in Latina patients with symptomatic pelvic organ prolapse (POP) on knowledge of condition, satisfaction with selected treatment and decisional conflict related to treatment selection. A 15-minute DAV was developed, covering information about POP and details of treatment options following a written decision aid guide for POP patients (www.ohri.ca/decisionaid). Latina patients referred to the TTUHSC El Paso Urogynecology Clinic for initial evaluation with symptomatic POP were recruited and randomized to “intervention” or “standard care” groups. Those in the “intervention” group reviewed the DAV prior to consultation with a Urogyn specialist. The “standard care” women underwent consultation as per routine. Outcomes of the study included assessment of knowledge of condition using a 12-item questionnaire (Prolapse and Incontinence Knowledge Quiz-POP scale); satisfaction with selected treatment using the 6-item satisfaction with decision scale for pelvic floor disorders (SDS-PFD); and decisional conflict using a 16-item decisional conflict scale (DCS). Outcomes were assessed immediately after initial visit (baseline), and at 1, 3, and 6 month timepoints. Data was analyzed using Student’s t-test comparisons between groups at each timepoint. Categorical variable analysis was performed using Fisher’s exact test as appropriate. Thirty patients were randomized to “intervention” (n = 15) or “standard care” (n = 15) groups. Mean participant age was 59.9 ± 9.3 and 60.6 ± 11.7 for each group, respectively. Distribution of POPQ stage was similar between groups (p = 0.658). Other baseline characteristics, including BMI, parity, and prior surgery did not differ between groups. At baseline, there were no differences in initial treatment selection between groups (conservative management, pessary, surgery; p = 0.28). Knowledge scores were higher in the intervention group at baseline (p = 0.024), but were similar between groups at subsequent timepoints. SDS-PFD scores were lower in the intervention group at 6 months (indicating higher satisfaction, p = 0.03). DCS overall scores were lower in the intervention group at 3 months (indicating lower decisional conflict, p = 0.04). Within the DCS subscales, the intervention group had lower “effective decision” scores at 3 and 6 months (p = 0.05 and p = 0.04, respectively). The “effective decision” subscale measures satisfaction and how “good” the treatment decision was for the patient. All other DCS subscores were similar between groups at each timepoint. Within the 6 month study period, 13.3% of women in the “intervention” group changed their initial treatment selection, compared with 33.3% of women in the “standard care” group. Six months after initial visit, 86.7% of those in the intervention group and 60% of those in the standard care group had opted for surgery (p = 0.005). A DAV intervention in Latina patients with POP prior to initial evaluation may help the patient make a more effective initial treatment decision, leading to greater long-term satisfaction with such selection. Given the small sample size in this pilot study, confirmation in larger-scale study is necessary.