21: Characterizing anxiety at the first encounter in women presenting to the urogynecology clinic: the Café Study

Abstract

Anxiety can be measured in various ways. State anxiety is temporary and is sensitive to change, while trait anxiety is a generalized propensity to be anxious. Our objective is to characterize the reasons for anxiety in women presenting for their initial urogynecologic consultation, to measure the change in participant anxiety after the visit, and to correlate the degree of anxiety improvement with visit satisfaction. All new patients presenting to our tertiary Urogynecology clinic were invited to participate in this IRB approved study. Following consent, participants completed pre- and post-visit questionnaires. The pre-visit questionnaires included the Pelvic Floor Distress Inventory (PFDI), Generalized Anxiety Disorder-7 (GAD), and the Spielberg State Trait Anxiety Inventory (STAI) Y6. Participants were also asked to list their pre-visit anxieties. The provider was blinded to any of the pre and post-visit questionnaire responses. The post-visit questionnaires consisted of the STAI-Y6, patient global impression of improvement (PGI-I) of participant anxiety, patient satisfaction, and the participant’s perception of how their anxiety was address during the visit. The anxieties listed by participants were reviewed independently by 2 authors (TP and YC) and categorized. A third-party panel arbitrated when there were disagreements among anxiety categories. A total of 50 women, primarily white (66%), with an average age of 53 years (range 21-86) completed the study. The visit diagnoses included: POP (20%), UUI (46%), SUI (54%), recurrent UTI (12%), and myofascial pain (28%). 22% of participants had a history of anxiety diagnosis. The average pre-visit STAI score was 42.9 (SD=11.98) which decreased by 12.60 points post-visit (Figure 1). Post-visit decreased anxiety was associated with improvements in the PGI-I scores and with the perception that participant anxiety was completely addressed. The most reported causes for consultation-related anxiety were: lack of knowledge of diagnosis and ramifications, fear of no solution/persistent suffering, and fear of pelvic exam. Participants reported the following reasons why their anxiety improved: patient education, reassurance, good bedside manner, and clear diagnosis with an acceptable treatment plan. Participants reporting complete satisfaction demonstrated a greater decrease in post-visit STAI scores compared to participants not reporting complete satisfaction. Changes in the STAI score were not associated with the PFDI or GAD scores. Women with the highest satisfaction following their initial Urogynecology visit also demonstrate the largest decreases in anxiety following the visit. Changes in anxiety scores were not correlated with the PFDI or with measures of generalized anxiety (GAD-7).