Patient-selected goals: A new perspective on surgical outcome

Elkadry, Eman; Kenton, Kimberly; FitzGerald, Mary P.; Shott, Susan; Brubaker, Linda

doi:10.1016/s0002-9378(03)00932-3

Cited by 232 publications

(151 citation statements)

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“…In both short (6-12 weeks) and longer term (1-3 years) follow-up, patient self-reported goal achievement was maintained, and associated with higher quality of life (12). Similar findings were noted by Elkadry et al (9) who described an association between post-operative patient satisfaction and goal attainment at three months. Paradoxically, a lack of association between objective cure and satisfaction was also noted in this study.…”

Section: Introductionsupporting

confidence: 81%

“…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%

See 1 more Smart Citation

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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Section: Introductionsupporting

confidence: 81%

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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“…In the metaanalysis, most trials examined immediate patient comprehension; fewer studies examined patient recall following their procedure as we did. It is unclear whether better recall would decrease decision regret, although others have found that women who feel unprepared for their surgery report high rates of dissatisfaction postoperatively [13].…”

Section: Discussionmentioning

confidence: 99%

Patient Recall 6 Weeks After Surgical Consent for Midurethral Sling Using Mesh

Mcfadden¹,

Constantine

Hammil³

et al. 2013

Obstetrical &Amp; Gynecological Survey

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“…18 Similarly, the use of patient-orientated goals has been described as a more sensitive approach to counselling women and also in assessing outcome. 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.…”

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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Patient-selected goals: A new perspective on surgical outcome

Cited by 232 publications

References 20 publications

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

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

Patient Recall 6 Weeks After Surgical Consent for Midurethral Sling Using Mesh

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

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