Understanding Medical Decision-Making in Urogynecology: Insights from a Predominantly Hispanic Patient Population

To explore the role of health literacy in surgical decision making in a predominately Hispanic population, we designed a mixed-methods approach to assess patient's literacy and explore what drives their choices for their healthcare. Understanding these factors will guide physicians to improve patient education, engagement and provide equitable care. In this IRB-approved study, English- and Spanish-speaking patients offered urogynecology surgery at our tertiary center were recruited. Participants completed the Short Assessment of Health Literacy (SAHL), a demographic survey, and a semi-structured interview to gain insight into their medical decision-making process. Data were analyzed using chi-square and t-tests, with p < 0.05 considered statistically significant. Grounded theory guided qualitative analysis of interview transcripts. Among 62 participants, most patients (90.3%) had sufficient health literacy. Mean SAHL scores did not differ between those electing for surgery and those declining. While Hispanic patients did tend to have lower SAHL scores (16.3) than non-Hispanic patients (17.1) (p = 0.04), the average still suggested adequate literacy. Interviews revealed that patients electing surgery often cited comfort with their physician (p = 0.01), definitive treatment (p = < 0.01), and friends' experiences (p = 0.04) as influential factors. The influence of personal faith was brought up by nineteen participants (13 electing for surgery, 6 declining surgery, p = 0.11). Our research revealed that our patient population tends to have adequate health literacy. Interviews revealed themes that influence choices, such as trust in their physician and patient's faith. Further investigation into the role that social factors play will be critical for better understanding patient surgical decision making.