Physician awareness of patients’ preferred level of involvement in decision-making at the initial urogynecology visit: a randomized trial

• Published in: American journal of obstetrics and gynecology 2024-01, Vol.230 (1), p.81.e1-81.e9
• Main Authors: Nwachokor, Jasmin, Rochlin, Emma K., Gevelinger, Matthew, Yadav, Menaka, Adams, William, Fitzgerald, Colleen, Acevedo-alvarez, Marian, Mueller, Elizabeth.R., Pham, Thythy T.
• Format: Article
• Language: English
• Subjects: Decision-making; patient autonomy; patient preferences; patient satisfaction; pelvic floor disorders; physician awareness; urogynecology
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2023.06.024

Studies have shown up to a 40% discordance between patients’ preferred roles in decision-making before and their perceived roles after their visit. This can negatively affect patients’ experiences; interventions to minimize this discordance may significantly improve patient satisfaction. We aimed to determine whether physicians’ awareness of patients’ preferred involvement in decision-making before their initial urogynecology visit affects patients’ perceived level of involvement after their visit. This randomized controlled trial enrolled adult English-speaking women presenting for their initial visit at an academic urogynecology clinic from June 2022 to September 2022. Before the visit, participants completed the Control Preference Scale to determine the patient’s preferred level of decision-making: active, collaborative, or passive. The participants were randomized to either the physician team being aware of their decision-making preference prior to the visit or usual care. The participants were blinded. After the visit, participants again completed a Control Preference Scale and the Patient Global Impression of Improvement, CollaboRATE, patient satisfaction, and health literacy questionnaires. Fisher exact, logistic regression, and generalized estimating equations were used. Based on a 21% difference in preferred and perceived discordance, we calculated the sample size to be 50 patients in each arm to achieve 80% power Women (n = 100) with a mean age of 52.9 years (SD = 15.8) participated in the study. Most participants identified as White (73%) and non-Hispanic (70%). Before the visit, most women preferred an active role (61%) and few preferred a passive role (7%). There was no significant difference between the two cohorts in the discordance between their pre-and-post Control Preference Scale responses (27% versus 37%; p = .39) or whether their symptoms were much better or very much better following the visit (18% versus 37%; p = .06). However, when asked whether they were completely satisfied with the visit, those assigned to the physician awareness cohort reported higher satisfaction than those in the treatment as usual cohort (100% versus 90%; p = .03). Although there was no significant decrease in discordance between the patient's desired and perceived level of decision-making following physician awareness, it had a significant impact on patient satisfaction. In fact, all patients whose physicians were aware of their preferences reported complete