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304 Decision-making interventions for pelvic organ prolapse: a systematic review, meta-analysis, and environmental scan
  1. Renata W Yen1,2,
  2. Amanda C Coyle3,
  3. Kim Siwak4,
  4. Johanna W Aarts5,
  5. Laura Spinnewijn6,
  6. Paul J Barr1,2
  1. 1Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
  2. 2The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
  3. 3Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
  4. 4Queen’s University, Kingston, Ontario, Canada
  5. 5Department of Obstetrics and Gynaecology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
  6. 6Department of Obstetrics and Gynaecology, Radboudumc University Medical Center, Nijmegen, The Netherlands

Abstract

Introduction People diagnosed with pelvic organ prolapse (POP) face preference-sensitive treatment decisions. We conducted a systematic review and meta-analysis to determine the effect of decision-making interventions for POP on patient-reported outcomes. To gain a more complete understanding of all potentially accessed resources, we also conducted an environmental scan to determine the quantity and quality of online interventions for POP decision-making.

Methods We searched databases (inception to August 2022), trial registries, and reference lists. We included studies that compared a decision-making intervention to usual care among patients with POP. We calculated mean difference (MD), 95% confidence intervals (CIs), and statistical heterogeneity (I2) or narratively summarized outcomes. For the environmental scan, we also searched Google, app stores, and clinical society websites. We assessed intervention quality using DISCERN, the IPDAS checklist, and readability metrics.

Results We identified seven publications, including 475 patients (mean age, 60 years) across three countries. There were no differences in decisional conflict (MD 0.09, 95% CI -2.91, 3.09, I2=0%), decision regret (MD 0.00, 95%CI -0.22, 0.22, I2=0%), satisfaction (MD -0.10, 95%CI -0.23, 0.03, I2=0%), knowledge, or shared decision-making. Study quality was low to moderate. We included 31 interventions from the environmental scan: 22/31 were not interactive, quality was low (mean DISCERN=48.1/80), and mean reading grade level of 10.2.

Discussion Existing interventions for POP did not improve patient-reported outcomes. Interventions were not tested in younger populations. The quality of online interventions is generally low with poor readability. Future research should address these gaps through the user-centered design of digital interventions with younger patients.

Conclusions We urgently need to develop high-quality, engaging interventions for POP, especially in younger age groups.

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