Randomized trial of a web-based tool for prolapse: Impact on patient understanding and provider counseling

International Urogynecology Journal (Impact Factor: 1.96). 03/2014; 25(8). DOI: 10.1007/s00192-014-2364-3
Source: PubMed


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.

5 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Given limited information regarding digital technology use among patients, we sought to evaluate Internet use among younger (<65 years) as compared to older (≥65 years) women and to assess factors associated with Internet use. We administered an anonymous questionnaire on digital technology use to English-speaking women who presented to our Urogynecology practice during a 1-month period. The questionnaire assessed the following sociodemographics: age, race, education, income, and insurance status. For our primary outcome, we assessed Internet use among younger versus older women. We also conducted a logistic regression analysis to evaluate the association of age with Internet use, while adjusting for potential confounders. A total of 556 women presented during the study period. Among these women, 506 completed the survey, for a 91% response rate. There were 282 (55.7%) younger women and 222 (43.9%) older women. Most of the younger and older cohorts were white (77% vs 86.5%, P = 0.02). Younger women were more educated (79.8% vs 59.5% ≥ college education; P < 0.0001) and had a higher income (58.3% vs 39.8% ≥ $50,000; P < 0.0001). For our primary outcome, younger women were significantly more likely to use the Internet (93.8% vs 66.3%, P < 0.001). In a logistic regression model which adjusted for age, race, education, and income, younger women remained significantly more likely to use the Internet (odds ratio, 6.6; 95% CI, 3.4-13.0). Although women younger than 65 years reported greater Internet use when compared to women 65 years or older, most of older women also used the Internet.
    No preview · Article · Feb 2015 · Journal of Pelvic Medicine and Surgery