Decision aids and shared decision making in urogynecology

To examine the efficacy and acceptability of decision aids (DAs) in counseling urogynecology patients with prolapse, stress urinary incontinence, or refractory overactive bladder.

This pilot study enrolled 33 patients into a control group that underwent usual care without a DA, followed by 33 patients into an intervention group where providers utilized a DA for counseling. Postvisit patient surveys assessed differences in treatment preference, knowledge, and in patient-physician collaboration using SURE, CollaboRATE, and Shared Decision Making (SDM) Process scales. Postvisit provider surveys assessed their perception of the usefulness and the difficulty of using a DA and visit length. Independent t tests were used for continuous variables (Knowledge and SDM Process scores) and Chi-Square for categorical variables (treatment preference, SURE, and CollaboRATE).

The majority of eligible patients 66/71 (93%) completed the survey. The intervention group trended toward higher knowledge scores (72% vs 60%, P  = 0.06), clearer treatment preferences (85% vs 67%, P  = 0.08), higher rates of top SURE scale scores (91% vs 73%, P  = 0.11), and top CollaboRATE scores (75% vs 52%, P  = 0.07). SDM process scores were similar across groups (3.2 vs 3.2, P  = 0.96). Providers used the DA in 73% of intervention group visits and rated the visit length as "normal" in both groups (70% vs 76%, P  = 0.78).

There were no statistically significant differences between the control group and the intervention group. The use of DAs was acceptable to providers and indicated a trend toward increased patient knowledge, treatment preference, and satisfaction. A larger study is warranted to examine the impact of DAs on decision making and patient experience.