Interactive Web-Based Tool for Pelvic Organ Prolapse: Impact on Patient Understanding and Provider Counseling

Abstract

To compare standard counseling (SC) versus an interactive patient/provider counseling process using a web-based tool (iPad™) on patient understanding, anxiety, and satisfaction regarding prolapse symptoms. Randomized controlled trial. University of North Carolina Hospital. Ninety women with vaginal bulge symptoms presenting for a new patient visit were needed to detect a 30% difference in improvement in understanding using SC versus SC plus iPad™. Women completed a questionnaire before and after a new patient visit regarding satisfaction with pelvic organ prolapse knowledge and related anxiety. After a new patient visit, subjects were randomized to SC, or SC plus use of an iPad™ interactive application. After counseling, women were surveyed on satisfaction with the counseling method. Ninety women were randomized to either SC (n=44) or SC with iPad™ (n=46). At baseline, 47% of women reported being satisfied/extremely satisfied with their understanding of bulge symptoms (50% SC vs 43.5% SC plus iPad™, p=.5). After counseling, both groups reported increased satisfaction with understanding of bulge symptoms (p<.0001) with no difference seen between counseling methods (42/44 (95.5%) SC vs. 45/46 (97.8%) SC with iPad™, p=.5). Baseline anxiety regarding bulge symptoms was high, with 65.9% and 73.9% of women in the SC and SC with iPad groups respectively reporting moderate/extreme anxiety (p=.4). After counseling, rates of moderate/extreme anxiety decreased significantly in both groups (p<.0001) with similar improvement between groups (31.8% SC vs 28.3% SC plus iPad, p=.7). Women were equally satisfied with either counseling method (43/44 SC vs 46/46 SC plus iPad™, p=.3). Use of iPad™ did not significantly change counseling time (9.5 min. SC vs. 8.9 min. SC plus iPad, p=.4). Interactive patient/provider counseling, with or without iPad™ use, was significantly associated with increased patient satisfaction with understanding of bulge symptoms and decreased patient anxiety. The iPad™ was easily integrated into the counseling sessions.