Impact of Patients Decision Aids on Shared Decision-Making and Patient Satisfaction Prior to Pelvic Floor Surgery.

Abstract

<h4>Objective</h4>Evaluate usability and utility of National Institute for Clinical Excellence (NICE) Patient Decision Aid's (PtDA's) for pelvic floor surgery. PtDA's reviewed were uterine prolapse, vault prolapse and stress urinary incontinence (SUI).<h4>Design</h4>Ten women given the PtDA's during routine clinical care were recruited from each cohort and underwent a semi-structured interview with a clinical researcher.<h4>Setting</h4>Urogynaecology outpatients in an NHS tertiary teaching hospital.<h4>Population or sample</h4>Women considering surgical management of uterine/vault prolapse or SUI. Exclusion criteria included those under 18, unable to communicate in English or not eligible for all surgical options discussed in the PtDA's.<h4>Methods</h4>A qualitative, semi-structured interview evaluating women's opinions of the decision aid and the way in which they utilised the PtDA was conducted. The interviews were recorded and transcribed prior to undertaking thematic analysis utilising NVivo software.<h4>Main outcome measure</h4>The outcomes of interest were feedback for content, language, format and usage of the PtDA's and women's usage of PtDA's in decision-making.<h4>Results</h4>Amendments suggested included removal of mesh from the SUI PtDA as this is not routinely available on the NHS and addition of a statement regarding the use of mesh in prolapse surgery. Additional anatomical diagrams were suggested. The need for a robust and regular update system was highlighted as was the provision of foreign language, audio and electronic versions.<h4>Conclusions</h4>PtDA's need updating to ensure relevant content. Clear, detailed and relevant information is required alongside active clinician engagement to reach a mutually agreeable treatment plan.