From the Department of Obstetrics and Gynecology and Division of Urogynecology, University of New Mexico Health Science Center, Albuquerque, NM.
Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, TX.
Female Pelvic Med Reconstr Surg. 2020 Aug;26(8):470-476. doi: 10.1097/SPV.0000000000000784.
Peer counseling may improve upon provider counseling and enhance patient preparedness for midurethral sling (MUS) surgery. We aimed to compare the impact of peer-centered versus standard preoperative video counseling by assessing patient preparedness for MUS surgery.
Women undergoing MUS were randomized to view either a peer-centered (PEER) or standard physician preoperative counseling video (PHYS). The PEER video featured a woman who had undergone MUS surgery and included the standard risks and benefits as well as additional information identified in prior work as important to patients. The PHYS video featured a surgeon discussing risks and benefits. Patients viewed either video at their preoperative visit and completed the Patient Preparedness Questionnaire (PPQ), Surgical Decision Satisfaction, Decisional Regret Scale, and the Urogenital Distress Inventory Short Form. Patients then underwent standard in-person surgeon counseling. Sessions were timed and compared with historical timed sessions. Our primary outcome was between-group differences in 6-week postoperative PPQ scores.
Patient Preparedness Questionnaire scores did not differ between groups (postoperative PPQ scores: median [interquartile range], 95 [84, 100] vs 92 [80, 100]; P=0.50). The PEER group reported higher decisional regret (15 [0, 28.75] vs 0 [0, 10], P=0.02) and less symptom improvement on Urogenital Distress Inventory Short Form change scores compared with the PHYS group (47.2 [37.2, 62.5] vs 36.1 [16.5, 50], P=0.03); secondary outcomes were not different between groups. In-person counseling times decreased after watching either video compared with the institution's historical standard (8:27 minutes [08:56, 17:14] vs 11:34 minutes [5:22, 13:07]; P < 0.005).
Patient preparedness did not differ between groups. Decision regret did not differ between groups once adjusted for urinary symptoms.
同伴咨询可能优于提供咨询，并增强患者对中尿道吊带（MUS）手术的准备。我们旨在通过评估患者对 MUS 手术的准备情况，比较以同伴为中心与标准术前视频咨询对患者的影响。
接受 MUS 手术的女性患者被随机分为观看同伴为中心（PEER）或标准医生术前咨询视频（PHYS）组。PEER 视频以接受过 MUS 手术的女性为特色，包括标准的风险和益处，以及先前研究中确定的对患者重要的其他信息。PHYS 视频以外科医生讨论风险和益处为特色。患者在术前就诊时观看任一视频，并完成患者准备问卷（PPQ）、手术决策满意度、决策后悔量表和泌尿生殖窘迫量表简表。然后，患者接受标准的当面外科医生咨询。对会议时间进行计时，并与历史上的计时会议进行比较。我们的主要结局是术后 6 周时两组之间的 PPQ 评分差异。
两组患者的患者准备问卷评分无差异（术后 PPQ 评分：中位数[四分位距]，95[84，100]比 92[80，100]；P=0.50）。与 PHYS 组相比，PEER 组报告的决策后悔更高（15[0，28.75]比 0[0，10]；P=0.02），泌尿生殖窘迫量表简表的症状改善评分更低（47.2[37.2，62.5]比 36.1[16.5，50]；P=0.03）；两组的次要结局无差异。与机构的历史标准相比，观看任何视频后的当面咨询时间都减少了（8:27 分钟[08:56，17:14]比 11:34 分钟[5:22，13:07]；P<0.005）。
两组患者的准备情况无差异。调整尿症状后，两组之间的决策后悔无差异。
