Impact of a Web-Based Decisional Aid on Satisfaction in Women Undergoing Prolapse Surgery

Objectives The objective of this study was to determine whether a computerized, condition-specific Decision Analysis Tool (DAT) for the surgical treatment of pelvic organ prolapse (POP) improves patient satisfaction and alters decision making. Methods Together with a health care startup company, we created a computerized DAT using the best evidence available on success rates and risks associated with sacrocolpopexy, native tissue apical suspension, and colpocleisis. Consecutively scheduled women before and after implementation of the DAT in an academic practice of 4 fellowship-trained, board-certified urogynecologists were included. The primary outcome was patient satisfaction using the Satisfaction with Decision Scale (SDS). Secondary outcomes included the Decision Regret Scale (DRS) questionnaire, differences in surgical choice, patient-reported outcomes, and individual SDS and DRS items. The SDS and DRS were administered at the 3-month postoperative visit. Results Forty-seven women before DAT implementation and 54 women after DAT implementation were included. There were no differences in SDS or DRS total scores (4.62 ± 0.66 vs 4.52 ± 0.72, P = 0.10 and 1.48 ± 0.79 vs 1.52 ± 0.82, P = 0.77) or individual question responses between groups. Women using the DAT were more likely to choose sacrocolpopexy than those who did not (76% vs 51%, P = 0.01). All 3 procedures led to similarly improved POP symptoms (P = 0.98), but those who underwent sacrocolpopexy had higher SDS scores compared with native tissue or colpocleisis patients (P = 0.01). Several individual SDS and DRS items were more favorable after sacrocolpopexy. Conclusions Women choosing surgery for POP are satisfied with their decision-making experiences with and without the assistance of a DAT. More women using a DAT, however, undergo sacrocolpopexy, which is associated with improved satisfaction.