Patient-centered surgical outcomes: The impact of goal achievement and urge incontinence on patient satisfaction one year after surgery

Mahajan, Sahil; Elkadry, Eman; Kenton, Kimberly; Shott, Susan; Brubaker, Linda

doi:10.1016/j.ajog.2005.08.043

Cited by 113 publications

(74 citation statements)

References 7 publications

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“…19 In addition, there is also considerable evidence that there may be a discrepancy between patient satisfaction and objective outcome measures, meaning that a patient's goal-driven approach is more clinically meaningful. 20 This global approach to individualising patient goals and expectations may ultimately lead to a greater understanding of patient's expectations and also improve patient satisfaction. 21 Our findings, based on the qualitative analysis, would also seem to support the greater sensitivity of a goal-based approach, when compared with QoL assessment, in identifying individual patient needs.…”

Section: Discussionmentioning

confidence: 99%

Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration

Srikrishna

Robinson

Cardozo

et al. 2008

BJOG

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Objective To explore the expectations and goals of women undergoing surgery for urogenital prolapse using both a quantitative quality of life approach exploring symptom bother and a qualitative interview-based approach exploring patient goals and expectations.Design Prospective observational study.Setting Tertiary referral centre for urogynaecology.Population Forty-three women with symptomatic pelvic organ prolapse were recruited from the waiting list for pelvic floor reconstructive surgery.Methods All women were assessed with a structured clinical interview on an individual basis. The data obtained were transcribed verbatim and then analysed thematically based on the grounded theory. Individual codes and subcodes were identified to develop a coding framework. The prolapse quality-of-life (pQoL) questionnaire was used to determine the impact of pelvic organ prolapse on the woman's daily life. We arbitrarily classified 'bother' as minimal, mild, moderate and marked if scores ranged from 0 to 25, 25-50, 50-75 and 75-100, respectively. The degree of prolapse was objectively quantified using the pelvic organ prolapse quantification (POP-Q) system. Quantitative data were analysed using SPSS. Ethical approval was obtained from the Kings College Hospital Ethics Committee.Main outcome measures Quantitative data from POP-Q, subjective data from pQoL, qualitative data based on the structured clinical interview.Results Forty-three women were recruited over the first 1 year of the study. Their mean age was 56 years (range 36-78) and mean parity was 2 (range 0-6). The mean ordinal stage of the prolapse was 2 (range stages 1-4). Quantitative analysis of the pQoL data suggested that the main domains affected were prolapse impact on life (mean score 74.71) and personal relationships (mean score 46.66). Qualitative analysis based on the clinical interview suggested that these women were most affected by the actual physical symptoms of prolapse (bulge, pain and bowel problems) as well by the impact prolapse has on their sexual function.Conclusions While disease-specific QoL questionnaires allow broad comparisons to be made assessing patient bother, they may lack the sensitivity to assess individual symptoms. A qualitative approach may individualise patient care and ultimately improve patient satisfaction and overall outcome when treating women complaining of urogenital prolapse.Keywords Grounded theory, prolapse, qualitative analysis, quality of life. IntroductionUrogenital prolapse, while not life threatening, remains an important cause of morbidity in women and the effect on quality of life (QoL) has been extensively documented. 1 Increased life expectancy and an expanding elderly population means that urogenital prolapse remains an important condition particularly since the majority of women may now spend one-third of their lives in the postmenopausal state. 2 In a retrospective cohort study of 149 554 women, the lifetime risk of having surgery for urogenital prolapse was 11%, and 29.2% of women required repeat surgery. 3 The...

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Section: Discussionmentioning

confidence: 99%

Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration

Srikrishna

Robinson

Cardozo

et al. 2008

BJOG

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“…Historically, treatment outcomes for patients with urinary incontinence, pelvic organ prolapse, and anal incontinence have been defined in procedural, diagnostic, or symptom-based terms. More recently, efforts have focused on treatment dependant patient satisfaction, quality of life (QOL), and goal attainment (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…Paradoxically, a lack of association between objective cure and satisfaction was also noted in this study. A one year follow-up assessment by Mahajan et al (10) noted a decrease in patient satisfaction for those women who had symptoms of urge incontinence and less subjective goal attainment.…”

Section: Introductionmentioning

confidence: 99%

Surgical Versus Nonsurgical Treatment of Women With Pelvic Floor Dysfunction: Patient Centered Goals at 1 Year

et al. 2008

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Objective-In women with pelvic floor dysfunction (PFD), we assessed the degree to which treatment (surgical vs. non-surgical) was associated with achievement of patient-centered goals, satisfaction with care, and quality of life. Study design-Prospective cohort. Between September 2003 and December 2004we recruited women during their first referral visit for PFD treatment at our outpatient Urogynecology Clinic. At the first visit, women enumerated up to five personal treatment goals, and "anchored" each goal by anticipating best and worst possible outcomes. At 12 month follow-up, women were asked to indicate their level of goal attainment (−2, worst outcome; +2, best outcome). At baseline and follow-up, women completed short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) (range 0-100, high scores indicating greater impact or distress). Patients indicated level of treatment satisfaction on a 4 level ordinal scale.Results-Of the 127 study participants with complete data, 46 (36.2 %) were managed surgically and 81 (63.8%) non surgically. There were no major demographic differences between the two groups in terms of age, race, weight, prior PFD surgery, and vaginal parity. The surgical group was more likely to have received baseline diagnosis of pelvic organ prolapse (80 % vs 60 %, p = 0.0259), and be post-menopausal (89 % vs 72 %, p = 0.0261). There were no significant differences in the distribution of goal type (symptom relief, activity, self image, general health) by treatment status (p = 0.1074). Using logistic regression to adjust for age and baseline diagnosis, surgically managed patients at one year were significantly more likely to report complete primary goal attainment (odds ratio (OR) = 4.42; p = 0.0154) and complete treatment satisfaction (OR = 6.12; p = 0.0109). For all participants, one-year IIQ-7 and UDI-6 scores were significantly correlated with primary goal attainment scores.Correspondence: Kathie L. Hullfish, MD, Associate Professor, Department OB/GYN and Urology, PO Box 800726, UVA Health System, Charlottesville, VA 22908, O: 434-924-2103, Fax: 434-982-1841, Email: khullfish@virginia.edu. Condensation: self-described patient treatment goals are similar in surgical and non-surgical patients with pelvic floor dysfunction, but are more likely to be completely achieved in the surgical group one year later Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-In this non-randomized, prospective analysis, surgically managed patients with PFD had higher one-year self-described complete goal attainmen...

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“…(4,5,6,7) They found that patient satisfaction was associated with goal attainment at three month (4,6) and longer term follow-up. (5,7) Although patient satisfaction was associated with goal attainment and subjective improvement using validated symptom questionnaires, (7) patient satisfaction was not associated with objective evidence of cure of urinary incontinence. (4) This highlights the discrepancy between objective measures and patients' subjective impression of success.…”

Section: Commentmentioning

confidence: 99%

“…Studies with both short and longer term follow-up have investigated the use of Goal Attainment Scaling (GAS) to evaluate the success of pelvic floor support surgery from the patients' perspective. (4,5,6,7) Based on this prior work, GAS is well suited to evaluate pessary therapy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Patient-selected goal attainment for pessary wearers: what is the clinical relevance?

Komesu

Rogers

Rode

et al. 2008

American Journal of Obstetrics and Gynecology

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Objective-To evaluate whether patient determined goal achievement is associated with pessary continuation.Study Design-Patients identified goals they wished to achieve from pessary use. Patients were asked whether they continued pessary use and if goals were met 6-12 months later. Goals were divided into eight categories. Fisher's exact test was used to evaluate categorical variables, t-tests for continuous variables, and regression methods to calculate odds ratios (OR).Results-Eighty women enrolled in the study. Sixty-four had follow-up data. Goals commonly listed were bladder (36%), activity (20%), general health (13%), and prolapse related (11%). Thirty-four women continued and 30 discontinued pessary use. Women who continued pessary use were more likely to meet one or two goals (OR 17.5, respectively) Conclusion-Patient goals are variable and subjective. However, when assessed for achievement, they're associated with pessary continuation. Women who attain self-determined goals are likely to continue pessary use.

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Patient-centered surgical outcomes: The impact of goal achievement and urge incontinence on patient satisfaction one year after surgery

Cited by 113 publications

References 7 publications

Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration

Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration

Surgical Versus Nonsurgical Treatment of Women With Pelvic Floor Dysfunction: Patient Centered Goals at 1 Year

Patient-selected goal attainment for pessary wearers: what is the clinical relevance?

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