Patient Preparedness for Pelvic Organ Prolapse Surgery: A Randomized Equivalence Trial of Preoperative Counseling

Abstract

Objective Preoperative counseling can affect postoperative outcomes and satisfaction. We hypothesized that patient preparedness would be equivalent after preoperative counseling phone calls versus preoperative counseling office visits before prolapse surgery. Methods This was an equivalence randomized controlled trial of women undergoing pelvic organ prolapse surgery. Participants were randomized to receive standardized counseling via a preoperative phone call or office visit. The primary outcome was patient preparedness measured on a 5-point Likert scale by the Patient Preparedness Questionnaire at the postoperative visit. A predetermined equivalence margin of 20% was used. Two 1-sided tests for equivalence were used for the primary outcome. Results We randomized 120 women. The study was concluded early because of COVID-19 and subsequent surgery cancellations. There were 85 participants with primary outcome data (43 offices, 42 phones). Mean age was 62.0 years (±1.0) and 64 (75.3%) had stage III or stage IV prolapse. The primary outcome, patient preparedness measured at the postoperative visit, was equivalent between groups (office, n = 43 [97.7%]; phone, n = 42 [97.6%], P < 0.001). Most women reported they would have preferred a phone call (n = 66, 65.5%) with more women in the phone group expressing this preference than the office group (office 40.5% vs phone 90.5%, P < 0.001). Ultimately, nearly all women (96.5%) were satisfied with their method of counseling. Conclusions Preoperative counseling phone calls were equivalent to office visits for patient preparedness for pelvic organ prolapse surgery. This study demonstrates patient acceptance of phone calls for preoperative counseling. Telehealth modalities should be considered as an option for preoperative patient counseling.

Patient-Initiated Telephone Calls Before and After Introduction of an Enhanced Recovery After Surgery Protocol for Female Pelvic Reconstructive Surgery

“…Multiple studies have not found a difference in patients' understanding or improvement in patient surgical preparedness when implementing various educational materials 13–15 . Similarly, as our study highlights, the extensive written materials and verbal counseling provided as part of ERAS in an effort to improve perioperative care have not led to a decrease in patient phone calls, preoperatively or postoperatively.…”

“…Multiple studies have not found a difference in patients' understanding or improvement in patient surgical preparedness when implementing various educational materials. [13][14][15] Similarly, as our study highlights, the extensive written materials and verbal counseling provided as part of ERAS in an effort to improve perioperative care have not led to a decrease in patient phone calls, preoperatively or postoperatively. The high volume of phone calls does not necessarily mean that ERAS is not effective at mitigating postoperative concerns or improving the recovery, but rather reflects patients' reliance on personal communication and ineffective patient education.…”

In-Person Versus Video Preoperative Visit: A Randomized Clinical Trial

“…While our primary outcome, the PPQ, is not a validated questionnaire, it has been used in multiple other studies within FPMRS. [11][12][13] The participants' surgical procedures included a variety of approaches: vaginal, robotic, and laparoscopic. This allows for increased generalizability of our results.…”

How Do Orthopaedic Patients Prefer to Be Contacted During a Pandemic?

“…While phone calls remain the most popular form of communication with surgical patients' text messages have the benefits of being easily accessible, can be read at a convenient time for the patient, and will remain as a hard copy for future reference without requiring the patient to be held up speaking on the telephone at a time which may be inconvenient for them. Text messages have been shown to increase compliance with appointments and clinical protocols [ 19 , 20 ] as well as reduce anxiety levels before and after surgery both for patients and their family members [ 21 ]. There is also a big role that emails can play, especially amongst the younger population, as people have easy access to these on mobile phone devices.…”