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Race, Ethnicity, and Patient Preferences for Autonomy in Medical Decision-making regarding Prolapse

Thursday, October 5, 2023

11:35 AM – 11:39 AM US PST

Location: Oregon Ballroom

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Presenting Author(s)

Araba A. Jackson, MD (she/her/hers)

Attending Physician
Inova Health System
Falls Church, Virginia, United States

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Co-Author(s)

Julia K. Shinnick, MD (she/her/hers)

Assistant Professor of Obstetrics and Gynecology
Women & Infants Hospital/Brown University
Providence, Rhode Island, United States
Russell F. Stanley, DO

private practice urogynecologist
Christus Trinity Clinic/Christus Health System
Texarkana, Texas, United States
Russell F. Stanley, DO

private practice urogynecologist
Christus Trinity Clinic/Christus Health System
Texarkana, Texas, United States
TS

Tasha Serna-Gallegos, MD (she/her/hers)

Assistant Professor
Division of Urogynecology, Department of Ob/Gyn, University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
TS

Tasha Serna-Gallegos, MD (she/her/hers)

Assistant Professor
Division of Urogynecology, Department of Ob/Gyn, University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
BB

Brittni Boyd, MD

Fellow
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine
Irvine, California, United States
BB

Brittni Boyd, MD

Fellow
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine
Irvine, California, United States
Ivrose Joseph, MD

Fellow
Emory University
Atlanta, Georgia, United States
Ivrose Joseph, MD

Fellow
Emory University
Atlanta, Georgia, United States
Deepanjana Das, MD

Fellow
Division and Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University
Chicago, Illinois, United States
Deepanjana Das, MD

Fellow
Division and Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University
Chicago, Illinois, United States
AP

Anna Pancheshnikov, MD

Fellow
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Baltimore, Maryland, United States
AP

Anna Pancheshnikov, MD

Fellow
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Baltimore, Maryland, United States
FE

Franklin Enemuo, MBBS, MPH

Statistician
Women & Infants Hospital, Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
FE

Franklin Enemuo, MBBS, MPH

Statistician
Women & Infants Hospital, Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
MM

Matthew M Scarpaci, BS, MPH, BS, MPH

Statistician
Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, 02912
Providence, Rhode Island, United States
MM

Matthew M Scarpaci, BS, MPH, BS, MPH

Statistician
Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, 02912
Providence, Rhode Island, United States
Vivian Sung, MD MPH (she/her/hers)

Professor
Women and Infants Hospital/Alpert Medical School of Brown University,
Providence, Rhode Island, United States
Vivian Sung, MD MPH (she/her/hers)

Professor
Women and Infants Hospital/Alpert Medical School of Brown University,
Providence, Rhode Island, United States

Disclosure(s):

Araba A. Jackson, MD: No financial relationships to disclose

Julia K. Shinnick, MD: No financial relationships to disclose

Russell F. Stanley, DO: No financial relationships to disclose

Tasha Serna-Gallegos, MD: No financial relationships to disclose

Brittni Boyd, MD: No financial relationships to disclose

Ivrose Joseph, MD: No financial relationships to disclose

Deepanjana Das, MD: No financial relationships to disclose

Anna Pancheshnikov, MD: No financial relationships to disclose

Franklin Enemuo, MBBS, MPH: No financial relationships to disclose

Matthew M Scarpaci, BS, MPH, BS, MPH: No financial relationships to disclose

Vivian Sung, MD MPH: No financial relationships to disclose

Objectives: To compare the patient autonomy preferences reported by underrepresented patients (URPs) to non-URPs after new patient consultations with Urogynecology providers.

Methods: This was a planned secondary analysis of a prospective study of new patients ages >/= 18 years old who were counseled regarding management of POP from July 2021-December 2022 at eight centers in the United States. Participants self-reported demographic and treatment-related information before completing the Control Preference Scale (CPS) and Pelvic Floor Disorders Autonomy Preference Index (API), validated instruments measuring patient preferences for participation in decision making. (2) Lower scores on the CPS indicate stronger preferences for control in decision making and higher scores on the API indicate stronger preferences for participation in decision making. Race and ethnicity were viewed as social constructs categorized by self-identification. Patients were categorized as URPs if they identified with any non-white race or Hispanic ethnicity.

Results: 194 patients with mean age 63.2 (+/-11.0) and mean BMI 29.8 (+/-7) completed the study, with demographic information demonstrated in Table 1. A significantly greater proportion of URPs had hypertension (p=0.002) and a greater vaginal parity (p=0.010), while a greater proportion of non-URPs had a prior hysterectomy (p=0.04) and prior prolapse surgery (p=0.045). There were no differences in the other pelvic floor disorders addressed, POPQ stage, or PFDI-20 scores. Mean CPS scores were not different between groups when all URPs were analyzed together versus non-URPs (2.1+/- 1.0 versus 2.1 +/- 0.8, p= 0.36). However, mean CPS scores of Black patients were significantly lower than other URPs (1.7+/- 0.7 versus 2.2 +/- 1.1, p= 0.0409) and non-URPs (1.7 +/- 0.7 versus 2.1 +/- 0.8, p= 0.025). This difference was not significant when comparing Hispanic participants to other URPs and non-URPs nor when comparing non-English speaking patients to other URPs and non-URPs. Mean API-decision making scores were significantly lower in all URPs compared to non-URPs (59.3 +/- 18.3 versus 65.1 +/- 15.3, p= 0.041), as were mean decision-making and information-seeking scores (138.8 +/- 24.5 versus 148.4 +/- 20.2, p= 0.009). In Black patients compared to non-URPs, this difference was sustained (134.5 +/- 21.7 versus 148.4 +/- 20.2, p=0.003). Mean API-decision making and information seeking scores in non-English speaking patients were also significantly lower compared to non-URPs (138.8 +/- 21.8 versus 148.4 +/- 20.2, p= 0.023). There were no significant differences in mean API scores between Black and Hispanic patients with other URPs.

Conclusions: Non-URPs choosing between POP treatment options demonstrated a stronger desire for information and involvement in decision making than URPs overall. However, Black patients demonstrated a stronger desire for control over final decisions overall. Further investigation of patient automony preferences for prolapse-related decision making could aid in understanding these differences.