Association of Race Status and Pelvic Organ Prolapse Treatment Goal Identification and Assessment with Urogynecology Providers

Objectives: To report the proportion of patients whose treatment goals were able to be correctly identified by a provider at a new-patient visit for pelvic organ prolapse.

Methods: Exploratory analysis of a prospective cohort study of new patients aged > 18 years old who were evaluated and counseled regarding management of pelvic organ prolapse from July 2021-December 2022 at 8 geographically diverse centers in the United States. The primary study investigated a comparison of decisional conflict between underrepresented and non-underrepresented patients. Participants self-reported demographic and treatment goal-related information, with additional information abstracted from the medical record. The treatment goal questionnaire was designed to reflect goals for this patient population as established by previous work in the field. The questionnaire queried patients’ impressions of treatment discussions, treatment options, and their goals and beliefs about the next best step moving forward. Providers were also asked to report this same information. Patients and providers were allowed to select more than one treatment goal, and more than one treatment option moving forward (example: pessary and PFMT). Thus, results were reported as percent match. For the purposes of this study, race and ethnicity were viewed as social constructs categorized by self-identification. Patients were categorized as underrepresented if they identified with any non-white race or Hispanic ethnicity, as these are identified risk factors for treatment inequity, implicit bias and diverse adverse medical outcomes in the United States.

Results: 42 providers saw 97 underrepresented patients and 97 non-underrepresented patients with an overall mean age of 63.2 (+11) and mean BMI 29.8 (+7.0) in the primary study. Other demographic information is shown in Table 1. In just over one-third of both underrepresented and non-underrepresented patients were providers able to identify the patient’s most important goal of treatment (Table 2) (37.1%, underrepresented versus 42.2%, non-underrepresented, p=0.42). However, in nearly three quarters of patients, other treatment goals were correctly identified by providers, with no difference between groups (p=0.45). In approximately 90% of patients, 50% or greater of treatment options offered matched with provider with no difference between groups. Similarly, in approximately 75% of subjects 50% or greater of treatment options selected matched providers and in 80% of subjects, 100% of next steps right now matched providers, without differences in underrepresented versus non-underrepresented groups (Table 2).

Conclusions: This study demonstrated a notable discrepancy between patient and provider impression of most important goal of treatment was seen, however, there was no difference in this assessment with respect to self-identified race groups. Similarly, there were no differences between underrepresented and non-underrepresented groups and high correlation with providers in terms of treatments offered, treatment options selected and in next best steps. There may be room for improvement of patient and provider communication related to goals of prolapse treatment.