Patient Autonomy and Control Preferences in Prolapse Treatment Decision Making

Patient preferences regarding medical decision making are central to prolapse treatment discussions.

The objective of this study was to compare control preferences scale (CPS) and autonomy preference index (API) scores reported by underrepresented patients (UPs) to non-UPs after new patient consultations with urogynecology providers.

This was a planned secondary analysis of patients counseled regarding treatment of pelvic organ prolapse at 8 academic medical centers from July 2021 to December 2022. Participants completed the CPS (5-point scale, 1="I prefer to make the final decision" to 5="I prefer my doctor to make the decision"; scores 1-2 were considered preferring an "active" role). Participants also completed the API, which has 2 subscales (information seeking, 8 items; decision making, 6 items; scored 0-100) and 2 clinical vignettes (scored 0-20). Higher scores indicate stronger preferences for participation. P <0.05 is considered significant.

Two hundred seven participants were included; 103 (49.8%) identified as UP and 122 (59%) pursued surgery. The mean CPS scores were not different between UPs versus non-UPs (2.0 ± 1.0 vs 2.1 ± 0.8, P =0.35), and most participants preferred an active role in decision making (145/194, 74.7%). The mean API scores were different between groups (UP, 149.2 ± 27.7 vs non-UP, 159.4 ± 22.5, P =0.008). When adjusting for education, income, insurance, and prior prolapse surgery, self-identification with non-Hispanic Black race was associated with lower API scores compared with non-UPs (adjusted difference of 12.4, SE±5.1, P =0.023).

Autonomy preferences may vary, and most participants prefer an active role in prolapse treatment decision making.