Patients’ pelvic goals change after initial urogynecologic consultation

doi:10.1016/j.ajog.2007.08.021

American Journal of Obstetrics and Gynecology

Volume 197, Issue 6, December 2007, Pages 640.e1-640.e3

Presented at the 33rd Annual Scientific Meeting of the Society of Gynecologic Surgeons, Orlando, FL, April 12-14, 2007.

https://doi.org/10.1016/j.ajog.2007.08.021 Get rights and content

Objective

The objective of the study was to determine the effect of initial urogynecologic consultation on the number and type of patient goals.

Study Design

Charts of women who underwent initial urogynecology consultation were reviewed. Patient goals were collected before and after their consultation. Investigators categorized goals into 6 categories. Category and number of goals were compared before and after their first visit. Predictors of change and clinical associations were assessed.

Results

Sixty-three women with a mean age of 53 (range, 18-83) years reported a total number of 313 goals. The number of patients’ postconsultation goals was higher than the number of preconsultation goals, (median of 3 ± 1.2 vs 2 ± 1.2, respectively; P < .003). Women were less likely to report“ symptom” and “information-seeking” goals (P < .002 and P < .03, respectively) but more likely to report treatment goals after consultation (P < .001).

Conclusion

Urogynecologic consultation affects patients’ goals. It is important to reassess goals following initial consultation.

Section snippets

Materials and Methods

Following institutional review board approval, we reviewed the charts of consecutive women who completed pre- and postvisit goals at their initial urogynecologic consultation between July-October 2006. In addition, we recorded the following parameters: demographics, history and physical parameters, goal and questionnaire responses, and clinical diagnoses.

Before and at completion of their initial consultation, new patients presenting to our tertiary care urogynecology practice are asked to write

Results

Sixty-three women with a mean age of 53 (range, 18-83) years reported a total number of 313 pre- and postvisits. The total number of previsit goals was 138, whereas following the visit, it was 175. Most women were white (83%), with 9% African American and 8% Hispanic. The majority of patients had urinary incontinence (44%) and pelvic organ prolapse (41%) as their primary clinical diagnoses followed by pelvic pain (13%) and fecal incontinence (2%).

Comments

Women’s goals for treatment of their pelvic floor problems change after urogynecologic consultation as women shift the focus of their goals from symptom relief to treatment. In addition, they increased their number of goals. Not surprisingly, our data confirm the clinical suspicion that women’s most common presenting goals for pelvic floor consultation are to resolve their pelvic floor symptoms. Similar findings were also demonstrated in previous studies in which women before reconstructive

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There are more references available in the full text version of this article.

Cited by (17)

Characterizing anxiety at the first encounter in women presenting to the clinic: the CAFÉ study
2019, American Journal of Obstetrics and Gynecology
Clinically based anxiety questionnaires measure 2 forms of anxiety that are known as state anxiety and trait anxiety. State anxiety is temporary and is sensitive to change; trait anxiety is a generalized propensity to be anxious.
Our study aims to characterize the reasons for anxiety among women about the initial consultation for their pelvic floor disorders to measure change in participant state anxiety after the visit and to correlate improvement in anxiety with visit satisfaction.
All new patients at our tertiary urogynecology clinic were invited to participate. After giving consent, participants completed pre- and postvisit questionnaires. Providers were blinded to pre- and postvisit questionnaire responses. The previsit questionnaires included the Pelvic Floor Distress Inventory, the Generalized Anxiety Disorder-7, and the 6-item short form of the Spielberg State Trait Anxiety Inventory. Participants were also asked to list their previsit anxieties. The postvisit questionnaires comprised of the Spielberg State Trait Anxiety Inventory, patient global impression of improvement of participant anxiety, patient satisfaction, and the participant’s perception of whether her anxiety was addressed during the visit. The anxieties listed by participants were then reviewed independently and categorized by 2 of the authors. A separate panel arbitrated when there were disagreements among anxiety categories.
Fifty primarily white (66%) women with a median age of 53 years (interquartile range, 41–66) completed the study. The visit diagnoses included stress urinary incontinence (54%), urge urinary incontinence (46%), myofascial pain (28%), pelvic organ prolapse (20%), and recurrent urinary tract infection (12%). Less than one-quarter of participants (22%) had a history of anxiety diagnosis. The average previsit Spielberg State Trait Anxiety Inventory score was 42.9 (standard deviation, 11.98) which decreased by an average of 12.60 points in the postvisit (95% confidence interval, –16.56 to –8.64; P<.001). Postvisit decreased anxiety was associated with improvements in the patient global impression of improvement anxiety (P<.001) and participants’ perception that their anxiety symptoms had been addressed completely (P=.045). The most reported causes for consultation related anxiety were lack of knowledge of diagnosis and ramifications, personal or social issues, and fear of the physical examination. Participants reported that improvements in anxiety were related to patient education and reassurance, medical staff appreciation, and acceptable treatment plan. Participants who reported complete satisfaction demonstrated a greater decrease in the postvisit Spielberg State Trait Anxiety Inventory scores compared with the participants who did not report complete satisfaction (P=.045). Changes in the Spielberg State Trait Anxiety Inventory score were not associated with the Pelvic Floor Distress Inventory (P=.35) or Generalized Anxiety Disorder-7 scores (P=.78).
Women with the highest satisfaction after their initial urogynecology visit also demonstrated the largest decreases in anxiety after the visit. Changes in anxiety scores were not correlated with the Pelvic Floor Distress Inventory or with measures of generalized anxiety (Generalized Anxiety Disorder-7). Recognizing and addressing patient anxiety may help physicians better treat their patients and improve overall patient satisfaction.
Goal attainment after treatment in patients with symptomatic pelvic organ prolapse
2013, American Journal of Obstetrics and Gynecology
Citation Excerpt :
We did not assess goals prior to consultation. Others have shown that patients changed their goals after an initial urogynecologic visit; patients were less likely to report symptom and information-seeking goals initially and more likely to report treatment goals after consultation.14 Nonetheless, our cohort of women chose treatment of prolapse symptoms as their primary goal, and information seeking was not identified as a goal category in this cohort.
The objectives of this study were to: (1) assess differences in goal attainment of self-described goals after treatment of symptomatic pelvic organ prolapse (POP) for women who chose surgery compared to women who chose pessary; and (2) compare patient global improvement between groups.
Women who had symptomatic stage ≥II prolapse presenting for care of POP to the urogynecology clinic at the University of New Mexico were recruited. Patients listed up to 3 goals they had for their treatment. In addition, they completed the short forms of the Pelvic Floor Distress Inventory (PFDI-20), the POP/Urinary Incontinence Sexual Questionnaire, and the Body Image Scale. Goals listed by patients were then categorized into 10 categories. Each of the listed goals was categorized based on a consensus of 5 providers. At 3 months' follow-up patients listed if they had met their self-described goals on a scale of 0-10 and also answered the Patient Global Improvement Index (PGI-I).
There were no significant differences between the 2 groups' baseline characteristics. Surgery patients ranked their goal attainment higher than pessary patients for all the 3 goals listed. Similarly, PGI-I scores were also higher in the surgical (2.4 ± 1.1) than the pessary (1.93 ± 0.8) treatment groups (P < .04). Patients in the surgery group also had better symptom improvement as measured by the PFDI-20 (P < .02).
Patients who chose surgery had better global improvement and met their goals better compared to patients who chose pessary.
Do patient goals vary with stage of prolapse?
2011, American Journal of Obstetrics and Gynecology
Citation Excerpt :
This eliminated the potential influence of a discussion with the practitioner on goal selection and expectations for treatment. The literature suggests that women are more likely to report symptom goals and information seeking goals before consultation, and treatment goals after consultation.3 Weaknesses of our study include the smaller number of patients with stage 3 prolapse and the absence of patients with stage 4 prolapse.
To assess the relationship between stage of pelvic organ prolapse and self-expressed patient goals at initial urogynecologic evaluation.
From February to December of 2010, women presenting for evaluation of pelvic floor disorders were asked to identify up to 5 goals for treatment. Charts were reviewed for demographics. Patients were grouped according to stage of prolapse and goals were grouped into 9 categories.
Two hundred twenty-six women completed the questionnaire. Relief of urinary symptoms were the most commonly stated goal regardless of prolapse stage, pelvic organ prolapse quantitative-0 (59%), pelvic organ prolapse quantitative-I (78%), pelvic organ prolapse quantitative-II (55%), and pelvic organ prolapse quantitative-III (58%). Lifestyle, daily activity, and sexual function goals were the second, third, and fourth most common goals in all stages, respectively.
Resolution of urinary symptoms, ability to perform daily activities, and sexual function goals are at least as important as resolution of prolapse symptoms and may be the reason for seeking care.
Changes in sexual function after treatment for prolapse are related to the improvement in body image perception
2010, Journal of Sexual Medicine
Citation Excerpt :
As sexual function becomes a routine domain in our evaluation of women with pelvic floor dysfunction, our findings provide an important platform for discussion prior to prolapse treatment. As recognized in previous studies, outcome evaluations of treatments for pelvic floor disorders emphasize the importance of reporting both objective and subjective measures [5,6,11,18]. The concept of body image scale in patients with POP was introduced for the first time by Jelovsek et al., who recognized a correlation between POP and body image perception [9].
In a previous study, sexual function was related to a woman's self-perceived body image and degree of bother from pelvic organ prolapse (POP).
To evaluate sexual function, prolapse symptoms, and self-perceived body image 6 months following treatment for POP and to explore differences in body image perception and sexual function following conservative and surgical treatment for POP.
After institutional review board approval, consecutive women with ≥stage II POP were invited to participate. In addition to routine urogynecologic history and physical examination, including Pelvic Organ Prolapse Quantification (POP-Q), the participants completed three validated questionnaires before, and 6 months after, treatment for POP: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Modified Body Image Perception Scale and Prolapse subscale of Pelvic Floor Distress Inventory to assess condition specific bother from POP.
Changes in sexual function and body image perception following treatment for POP.
A total of 235 women with a mean age of 62 ± 12 years returned for a 6-month follow-up. The majority of our participants had surgical repair for POP (88%). At 6-month follow-up visits, the patients reported significant improvement in sexual function from baseline (33 ± 0.6 vs. 43 ± 0.8, respectively P < 0.0001). Improvement in sexual function, as measured by PISQ-12, was not significant among sexually active patients treated with a pessary compared with those treated surgically (–2.5 ± 5.5 vs. 11.5 ± 1, respectively P < 0.0001). A multivariate linear regression model demonstrated that body mass index and changes in body image perception were the only independent factors associated with changes in PISQ score following POP treatment (β = −0.5, P < 0.01 and β = −0.4, P < 0.03, respectively).
Resolution of POP symptoms after treatment improves women's self-perceived body image and sexual function. Not surprisingly, pessary is less effective in improving sexual function compared with surgical repair of POP. Lowenstein L, Gamble T, Sanses TVD, van Raalte H, Carberry C, Jakus S, Pham T, Nguyen A, Hoskey K, and Kenton K for the Fellow's Pelvic Research Network. Changes in sexual function after treatment for prolapse are related to the improvement in body image perception.
Patient-centered treatment goals for pelvic floor disorders: association with quality-of-life and patient satisfaction
2009, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Finally, we did not reassess goals after initial consultation, as we were interested in patient goals prior to the powerful influence of the physician. Because goals often change after consultation,29 future studies should examine the achievement of both preconsultation and postconsultation goals. Our results have implications both for research and practice.
We sought to determine the relationship of patient-centered goal achievement in pelvic floor disorder (PFD) treatment to PFD-specific quality-of-life (QOL), depression, health status, and patient satisfaction.
Ninety women with PFD identified up to 5 goals for treatment and reported their level of goal attainment (-2 to +2) at 1.5, 3, 6, and 12 months; completed the Incontinence Impact Questionnaire, Urogenital Distress Inventory, Incontinence Quality-of-Life Scale, Patient Health Questionnaire, and Short Form-12 Health Survey; and indicated their satisfaction with treatment.
Twelve-month mean goal attainment was moderately correlated with PFD-specific measures of QOL (r range, -0.40 to 0.55; P < .05) but less strongly with depression and general health status (r range, -0.27 to 0.28). Twelve-month goal attainment differed significantly among those who were completely satisfied (1.6 ± 0.5), very satisfied (1.2 ± 0.6), satisfied (0.4-1.0), or not satisfied (-0.5 ± 0.9; F = 24.2; P < .01). Earlier follow-up results were similar.
PFD treatment goal attainment is associated with improved condition-specific QOL and patient satisfaction.
Sexual function is related to body image perception in women with pelvic organ prolapse
2009, Journal of Sexual Medicine
Citation Excerpt :
Increasing emphasis is placed on patient-centered outcomes, when evaluating treatments, particularly for quality of life disorders. Outcome evaluations of treatments for pelvic floor disorders emphasize the importance of reporting both objective and subjective measures, such as global satisfaction, symptom distress, quality of life, and patient's goals for treatment, all of which likely encompasses sexual function and body image [14–17]. Our findings that vaginal topography does not necessarily predict sexual function or body image, support the assertion that simply restoring normal topography may not address patient's complaints.
A previous study demonstrated that women seeking treatment for advanced pelvic organ prolapsed (POP) reported decreased self-perceived body image and decreased quality of life.
To determine the relationship between: (i) sexual function and POP, (ii) self-perceived body image and POP; and (iii) sexual function and self-perceived body image in women with prolapse.
After IRB approval, consecutive women with POP stage II or greater presenting for urogynecologic care at one of eight academic medical centers in the United States were invited to participate. In addition to routine urogynecologic history and physical examination, including pelvic organ prolapse quantification (POPQ), consenting participants completed three validated questionnaires: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to assess sexual function; Modified Body Image Perception Scale (MBIS) to assess self-perceived body image; Prolapse subscale of Pelvic Floor Distress Inventory (POPDI-6) to assess condition specific bother from POP.
Pearson's correlations were used to investigate the relationship between independent variables.
Sexual function and modified body image score and its correlation with symptoms of POP.
Three hundred eighty-four participants with a mean age of 62 ± 12 years were enrolled. Median POPQ stage was 3 (range 2–4). 62% (N = 241) were sexually active and 77% (N = 304) were post-menopausal. Mean PISQ-12, MBIS, and POPDI scores were (33 ± 7, 6 ± 5, 39 ± 23, respectively). PISQ-12 scores were not related to stage or compartment (anterior, apical, or posterior) of POP (P > 0.5). Worse sexual function (lower PSIQ-12 scores) correlated with lower body image perception (higher MBIS scores) (rho = −0.39, P < 0001) and more bothersome POP (higher POPDI scores) (rho = −0.34, P < 0001).
Sexual function is related to a woman's self-perceived body image and degree of bother from POP regardless of vaginal topography. Sexual function may be more related to a woman's perception of her body image than to actual topographical changes from POP. Lowenstein L, Gamble T, Deniseiko Sanses TV, van Raalte H, Carberry C, Jakus S, Kambiss S, McAchran S, Pham T, Aschkenazi S, Hoskey K, and Kenton K. Sexual function is related to body image perceptionin women with pelvic organ prolapse. J Sex Med 2009;6:2286–2291.

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: Cite this article as: Lowenstein L, Kenton K, Pierce K, et al. Patients’ pelvic goals change after initial urogynecologic consultation. Am J Obstet Gynecol 2007;197:640.e1-640.e3.

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SGS meeting paperPatients’ pelvic goals change after initial urogynecologic consultation

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comments

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

SGS meeting paper
Patients’ pelvic goals change after initial urogynecologic consultation