Decision-making in Pelvic Floor Disorders: Translating Outcomes to Practice

Dartmouth College, Hanover NH

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Abstract

DESCRIPTION (provided by applicant): Pelvic floor disorders include a broad-range of health conditions that primarily affect women. These include bladder and bowel problems as well as problems of vaginal support. Treatments for pelvic floor disorders include surgical and non-surgical options with each having advantages and disadvantages that do not render a one best option for all women. Decision-making for women facing treatment of a pelvic floor disorder is complex and poorly understood by both patients and physicians. We seek to address this knowledge deficit and thereby improve the care of women affected by pelvic floor disorders. We propose to study decision satisfaction and its relationship with pelvic floor symptoms and quality of life. Using this and other patient information we next seek to create a decision tool that both informs patients of the advantages and disadvantages of the different treatments relevant to their disorder and elicits their values regarding those treatment characteristics. This tool could be used among physicians to better understand their decision priorities and thereby address any differences between patients and physicians and improve information dissemination between them. The decision-making process will be analyzed using a multi-criteria decision analysis technique called the analytic hierarchy process. The analytic hierarchy process is based on pairwise comparisons of decision elements that is simple to use and has been used in both business and medical applications. In completing this analysis a patient would be able to make a decision that is consistent with both her values and the available information regarding her problem and its treatments. The project consists of two phases. In Phase I decision and treatment characteristics are collected from a large database of women having already completed at least 3 months of a single treatment. Using information gathered from the first phase, Phase II involves the development of the decision tool. The aims of this proposal are to quantify decision satisfaction among women having completed assessment and any treatment of a pelvic floor disorder (Phase I) and to determine patient-centered treatment preferences using the analytic hierarchy process (Phase II). Additionally, treatment preferences will be explored among primary care physicians using the analytic hierarchy process. Understanding factors associated with high and low decision satisfaction as well as the decision priorities of women facing treatment for a pelvic floor disorder would improve women's health care by extending much needed decision aid to the treatment outcomes already known for these disorders. Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, The Center for Shared Decision Making, The Dartmouth Institute for Healthy Policy and Clinical Practice and the Tuck School of Business at Dartmouth offer a unique experience base to answer these factors and complete the proposed study. Dartmouth has been a leader in clinical shared decision-making and the application of a business-inspired analytical method. We propose to apply this process to the care of a common, complex women's health issue, a logical and needed step forward. PUBLIC HEALTH RELEVANCE: Pelvic floor problems are common in women and the treatment balances bladder, bowel and sexual functions in ways that are consistent with a woman's values. That balance includes information on how well a given treatment works, but also on how it impacts other pelvic floor functions. This study seeks to know those factors associated with good treatment decisions and to develop a simple decision-aid to improve decision support among women affected by a pelvic floor problem.