Introduction Among women worldwide, pelvic organ prolapse (POP) is a common problem. There are three different treatment options for POP: pelvic floor muscle therapy, pessary treatment and prolapse surgery.^1–3 As none of the three treatment options is clearly superior, shared decision making (SDM) is very important.⁴ A decision aid (DA) is known to facilitate patient participation and SDM.⁵ We hypothesize that the use of a web-based DA for POP increases patients‘ satisfaction with information and care and reduces decisional conflict.

Methods This two-arm, multicenter, cluster randomized controlled trial was performed in women with POP in five different Dutch hospitals. The control group received usual care (UC) and the intervention group received the DA in addition to UC. Primary outcome measures were satisfaction with treatment decision making and satisfaction with information. Analyses were performed using independent sample t tests, Chi-squared tests, and multilevel linear regression analyses.

Results Between the DA group (n=40) and the UC group (n=56) no differences were found concerning patients‘ satisfaction with information, with scores of 45.63 and 46.14 out of 50 respectively (p=0.67). Also, no differences were found concerning the perceived role in decision making, as patients scored in the DA group and 46.41 in the UC group, out of a maximum of 54 (n=0.81).

Discussion The high baseline patient satisfaction created a ceiling effect and might be caused by the patients being well educated and counselled effectively by the clinicians in the participating hospitals. Furthermore, there is only a small difference between UC and the DA, being value clarification exercises, as they provide the same information.

Conclusions No differences were found concerning patients‘ satisfaction with information and treatment decision making between the DA and UC. However, both groups scored high on the questionnaires, which suggests that the decision process is already of high quality.

References

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2. Li C, Gong Y, Wang B. Int Urogynecol J. 2016;27(7):981–992.

3. Mattsson NK, Karjalainen PK, Tolppanen AM, Heikkinen AM, Sintonen H, H’arkki P. Am J Obstet Gynaecol. 2020;222(6):588.e1–10.

4. Shay LA, Lafata JE. Med Decis Mak. 2015;35(1):114–131.

5. Stacey D, Legare F, Lewis K, Barry MJ, Bennett CL, Eden KB. Cochrane Database Syst Rev. 2017;4:CD001431.