Factors affecting perceived decision-making roles and satisfaction in the Urogynecology clinic

Objectives: Women presenting for care to a urogynecology clinic may experience different roles in decision-making. We aimed to characterize and compare patient-provided reasons for their decision-making roles and visit satisfaction.

Methods: We conducted a secondary analysis of an IRB-approved, randomized controlled trial of adult, English-speaking women presenting for their initial urogynecology visit. Before the visit, participants completed the Control Preference Scale (CPS), categorizing the role that they preferred in medical decision-making as active, collaborative, or passive. The participants were randomized to either the physician team being aware of their decision-making preference prior to the visit or usual care. After the visit, participants completed a post-visit CPS, indicating the role participants perceived they actually played in the decision-making and their visit satisfaction, assessed using a 5-point Likert scale. Participants also listed their top reasons justifying their post-visit CPS and visit satisfaction responses. All responses were reviewed independently by 3 authors and categorized. Discrepant categorization was resolved with a panel discussion. For this secondary analysis, we focused on the participants' post-visit CPS responses, visit satisfaction, and the reasons provided for their CPS and satisfaction responses; Chi-square tests compared the proportions of responses.

Results: One-hundred women with a mean age of 52.9 years (SD = 15.8) participated in the study. Most women reported an active role (43%), followed by collaborative (41%) and passive (16%) after the visit. 95% of women were completely satisfied. Four major categories emerged as reasons for the post-visit CPS responses (% of responses): relating to a collaborative visit (30%), receiving a thorough explanation (26%), the providers’ expertise/knowledge (16%), and getting reassurance/validation (7%). The reasons provided for the participants’ visit satisfaction were related to providers’ bedside manner (37%), undergoing a thorough evaluation (25%), and establishing a plan (18%). The reasons provided for the CPS responses differ amongst those who reported active, collaborative, and passive roles in decision-making (p=0,02). 50% of participants who reported a passive role on CPS gave reasons relating to providers’ expertise/knowledge; the majority of those who reported a collaborative (80.6%) or active role (67.8%) listed a collaborative visit or receiving a thorough explanation to justify their CPS responses (Figure1). The categorized reasons for visit satisfaction did not differ between those who reported complete satisfaction and those who did not. All participants who reported a collaborative role were completely satisfied, while 60% of the participants who were not completely satisfied reported a passive role in decision-making (p=0.01).

Conclusions: Women who reported active, collaborative, or passive roles in decision-making at their initial urogynecology visit provided different reasons justifying their roles. Awareness of these underlying themes can help providers better understand what patients value in decision-making and work to improve the patient experience.