Randomized trial of a web-based tool for prolapse: impact on patient understanding and provider counseling.
ABSTRACT Effective patient/provider communication is important to ensure patient understanding, safety, and satisfaction. Our hypothesis was that interactive patient/provider counseling using a web-based tool (iPad™ application) would have a greater impact on patient satisfaction with understanding prolapse symptoms compared with standard counseling (SC).
Women with complaints of seeing/sensing a vaginal bulge were enrolled in this randomized controlled trial. Participants completed pre- and postvisit Likert scale questionnaires on satisfaction with prolapse knowledge and related anxiety. After new patient histories and physical examinations, study participants were randomized to SC or SC with iPad™. Ninety participants were required to detect a 30 % difference in satisfaction with prolapse knowledge between the two groups.
Ninety women were randomized to SC (n = 44) or SC with iPad™ (n = 46). At baseline, 47 % of women were satisfied with their understanding of bulge symptoms (50 % SC vs. 43.5 % SC with iPad™, p = 0.5). After counseling, 97 % of women reported increased satisfaction with understanding of bulge symptoms (p < 0.0001), with no difference between groups [42/44 (95.5 %) SC vs. 45/46 (97.8 %) SC with iPad™, p = 0.5]. Baseline anxiety was high: 70 % (65.9 % SC vs. 73.9 % SC with iPad™, p = 0.4). After counseling, anxiety decreased to 30 % (p < 0.0001), with improvement in both groups (31.8 % SC vs. 28.3 % SC with iPad™, p = 0.7). Counseling times were similar between groups (9.5 min., SC vs. 8.9 min., SC with iPad, p = 0.4).
Interactive counseling was associated with increased patient satisfaction with understanding bulge symptoms and decreased anxiety whether a web-based tool was used or not.
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ABSTRACT: The objective of our study was to describe national rates of surgery for pelvic organ prolapse. We used the National Hospital Discharge Survey, a federal database that samples inpatient hospitals in the United States. Data from 1979 to 1997 were analyzed for diagnoses and procedures coded with the ICD-9-CM classification system. Age-adjusted rates were calculated by using the 1990 census population and compared for change over time by using the Score test for linear trend. Approximately 200,000 women undergo inpatient procedures for prolapse in the United States each year, ranging from 165,000 in 1988 to 226,000 in 1979. There was a significant decrease in the overall age-adjusted rate of procedures performed over the study period, from 2.2 to 1.5 procedures per 1000 women (P =.01). The rate of prolapse procedures for women younger than 50 years decreased by more than half (1.9 to 0.8 per 1000 women, P <.001), whereas the rate remained stable in women who were aged 50 years and older (2.7 to 3.3 per 1000 women, P =.5). Prolapse procedures are performed very frequently in the United States, although the rate has decreased slightly over time.American Journal of Obstetrics and Gynecology 01/2003; 188(1):108-15. · 3.97 Impact Factor
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ABSTRACT: An interactive digital education aid for breast reconstruction patients was developed because of a perceived need to provide patients with more education regarding the treatment so that they can make better informed treatment decisions. A prospective randomized study was conducted to assess its effectiveness. Breast cancer patients who were candidates for breast reconstruction were recruited and randomized into a control group and a study group. Both groups received routine assessment and education in the plastic surgery clinic, but the study group also watched the interactive digital education aid. Questionnaires assessing knowledge, anxiety, and satisfaction were administered (1) before the initial plastic surgery consultation, (2) immediately before surgery, and (3) 1 month after surgery. A total of 133 women participated, 66 in the control group and 67 in the study group. Women in both groups showed decreased anxiety, increased knowledge, and enhanced satisfaction with their decision-making ability associated with preoperative instructions about reconstructive surgery. However, the study group was significantly more satisfied than the control group with the method of receiving information and showed a less steep learning curve regarding the different techniques of breast reconstruction. They also tended to have a reduced mean level of anxiety and increased satisfaction with the treatment choice compared with the control group. An interactive digital education aid is a beneficial educational adjunct for patients contemplating breast reconstruction. Patients who use an interactive digital education aid demonstrate greater factual knowledge, reduced anxiety, and increased postoperative satisfaction compared with patients given preoperative instructions using standard methods alone. The benefit of an interactive digital education aid is expected to be higher in a broad-based practice setting outside of a comprehensive cancer center.Plastic and Reconstructive Surgery 10/2008; 122(3):717-24. · 3.33 Impact Factor
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ABSTRACT: Preparing cancer patients and their families for chemotherapy treatment is difficult. The challenge lies in finding ways to promote self-care and improve their ability to recall instructions. The aim of this study was to evaluate the usefulness of an educational video with regard to patients' ability to recall and report side effects of treatment. Patients referred for adjuvant chemotherapy for breast and colorectal cancer were randomized to receive standard pre-chemotherapy education or standard education plus addition of a video. Patients completed a base line questionnaire assessing existing knowledge and another questionnaire prior to the second chemotherapy cycle evaluating recall of information. Patients who watched the video were asked to assess the video after six cycles of chemotherapy. Telephone calls to the department reporting symptoms were monitored for both groups. The video group demonstrated trends towards higher recall in information concerning fever, mouth problems, low red cell count and prevention of constipation. They more commonly telephoned reporting medical problems of nausea, vomiting and signs of infection compared with the standard group. In summary, our study demonstrated inclusion of video to standard chemotherapy education improves retention of information regarding management of predictable chemotherapy side effects and reporting of treatment-related symptoms.European Journal of Cancer Care 07/2008; 17(4). · 1.31 Impact Factor