The impact of physician awareness on decision-making preferences in urogynecology

Physician awareness of a patient’s desired level of decision making improves patient satisfaction, according to a recent study published in The American Journal of Obstetrics & Gynecology.

Shared decision-making is vital for patient-centered care, especially for women with pelvic floor disorders which significantly impact their quality of life. Research has indicated patients are more satisfied, committed, and understanding of their treatment when actively involved in their care. However, the preferred level of involvement in decision making may vary between patients.

Prior research indicated 50% of women preferred active involvement in decision-making at their initial urogynecology visit, while 45% preferred collaborative participation, and 5% passive role. This discordance may lead to adverse patient outcomes, making interventions important to improve patient satisfaction.

To determine whether physician awareness of patients’ preferred involvement in decision-making impacted patients’ perceived involvement in decision-making after the initial urogynecology visit, investigators conducted a randomized controlled trial. Participants included adult, English-speaking women attending their initial visit at the Loyola urogynecology clinic.

Exclusion criteria included having previously seen a urogynecologist at Loyola and not being able to complete the surveys. Demographic information was obtained using the Control Preference Scale (CPS).

Patients’ preferred level of decision-making was evaluated in the CPS and included active, collaborative, and passive. Patients also completed a Pelvic Floor Distress Inventory (PFDI) and a standard patient intake questionnaire. 

Two groups were formed: the physician awareness (PA) group and the control group. In the PA group, providers saw CPS responses before the visit, while they were blinded to responses in the control group.Patients in the control group received treatment-as-usual (TAU). Standard intake questionnaire data was available across both groups.

Patients recompleted the CPS following the visit to determine their perceived role in decision-making. Collaboration between the patient and physician was evaluated using the CollaboRATE assessment, which had a maximum score of 27.

Patients also completed the Patient Global Impression of Improvement, which evaluated perceived changes in symptoms on a 7-point scale. Patient satisfaction was also evaluated using a 5-point scale, and the Short Test of Functional Health Literacy in Adults questionnaire was used to estimate patients’ understanding of health-related materials with a score of 0 to 36.

There were 49 patients in the TAU group and 51 in the PA group included in the final analysis. Patients were aged a mean 52.9 years, and 73% were White, 70.1% non-Hispanic, 32% had previously tried home behavioral therapy, 18% prior pelvic floor physical therapy, and 12% oral medications. A high-school level education or higher was reported in 95% of participants.

Urgency incontinence was the most commonly reported diagnosis, presenting in 67% of patients, followed by myofascial tenderness of the pelvic floor in 56% and organ prolapse in 26%. A mean PFDI score of 85.2 was reported, and the highest subscore was the Urinary Distress Inventory, with a mean score of 43.2.

Sixty-one percent of women preferred an active role prior to the visit, while only 7% preferred a passive role. The 2 groups did not vary in the post-visit change in CPS response. All patients were less likely to report an active consultation post-visit on the CPS compared to baseline. No significant difference was observed between both groups’ discordance rate.

In the TAU group, 93.5% of patients with preferred involvement reported satisfaction, vs 80% of those with a more passive role and 100% of those with an active role. All patients in the PA group were satisfied regardless of baseline level of involvement. Overall satisfaction across both groups were 89.8% in the TAU group and 100% in the PA group.

These results indicated physician awareness of patients’ preferred involvement in decision-making improves patient satisfactions. Investigators concluding asking patients about their preference should be the first step in delivering patient-centered care.

Reference

Nwachokor J, Rochlin EK, Gevelinger M, et al. Physician awareness of patients’ preferred level of involvement in decision-making at the initial urogynecology visit: a randomized trial. Am J Obstet Gynecol. 2024;230:81.e1-9. doi:10.1016/j.ajog.2023.06.024