Patient-centered goals for pelvic floor dysfunction surgery: what is success, and is it achieved?

Abstract

Objective: The purpose of this study was to describe patient-identified goals for pelvic floor dysfunction surgical procedures and patient-reported achievement of those goals.

Study design: Thirty-three consecutive patients scheduled for pelvic floor dysfunction surgical procedures completed a preoperative questionnaire on which they listed up to 5 personal goals for surgical outcomes. At 6- and 12-week follow-up, patients reported the degree (rated 1-5) to which each goal had been met (1 = strongly disagree that the goal was met; 5 = strongly agree). Age, race, vaginal parity, previous pelvic surgical procedures, pelvic floor dysfunction diagnosis, pelvic floor dysfunction surgical procedure, and perioperative complications were also recorded. Goals were categorized as being primarily related to symptom relief, increasing activity, general or other health concerns, social relationships and self-image, or physical appearance. Rates of self-reported goal achievement at 6 and 12 weeks were calculated, and differences in the proportion of goals achieved by category were assessed.

Results: Women reported a mean of 3.6 goals; 24 of 33 women (72.7%) listed > or = 4 goals. Of the 119 goals listed, 51 goals (42.9%) dealt with urinary or bowel symptoms; 36 goals (30.3%) dealt with improving activity; 15 goals (12.6%) dealt with general health concerns; 14 goals (11.8%) dealt with social relationships and self-image, and 3 goals (2.5%) dealt with physical appearance. Twenty-seven of the 33 women (81.8%) listed symptom relief; 22 women (66.7%) listed at least 1 activity-related goal; 14 women (42.4%) listed general or longer term health, and 11 women (33.3%) listed a social or self-image goal. Of the 119 goals listed, women agreed or strongly agreed that 88 goals (73.9%) were met at 6 weeks, and 101 goals (84.9%) were met at 12 weeks (chi(2) = 3.7 for difference between proportion at 6 and 12 weeks; P =.054). At 6 weeks, women agreed or strongly agreed that most goals had been met for activity, symptoms, general health, and appearance, but not for social/self-image goals (chi(2) = 24.9; P <.001). However, by 12 weeks, women agreed or strongly agreed that most goals had been met in all categories.

Conclusion: Women who undergo pelvic floor dysfunction surgical procedures have a variety of desired subjective outcomes. Goals that relate to social roles, sexuality, and self-image may take longer to successfully achieve than other types of goals. Longer-term follow-up is crucial to determine whether initial improvements have been maintained. Assessment of patient goals is quick and easy and may help clinicians better understand and care for their patients.