Patient Preparedness for Pelvic Organ Prolapse Surgery: A Randomized Equivalence Trial of Preoperative Counseling

Patient preparedness before surgery-a patient's readiness to undergo surgery, their related perioperative expectations, and postoperative satisfaction-has been shown to positively affect postoperative satisfaction and surgical outcomes. In a urogynecologic population, increased patient preparedness has been associated with improved symptoms and quality of life. Conversely, women who felt unprepared for pelvic organ prolapse (POP) surgery were more likely to report postoperative dissatisfaction and perceived complications. Health care providers and patients differ in their perception of complications and their severity. Several approaches to preoperative counseling have been used; recently, there has been increase in utilization of telehealth platforms. Telehealth counseling is convenient for both patient and health care provider and is efficient. In addition, the limited travel and decreased resource consumption lower costs. A previous study showed that telehealth services, specifically phone calls, were noninferior to office visits for postoperative care among a urogynecologic population and have the ability to make preoperative patient counseling more accessible. The aim of this randomized controlled trial was to determine if a preoperative counseling phone call is equivalent to a preoperative counseling office visit among women undergoing POP surgery. A second aim was to compare postoperative patient satisfaction with the decision to have surgery in women who received a preoperative counseling phone call and those with a preoperative counseling office visit. Participants were randomized 1:1 to receive either a preoperative counseling phone call or office visit. The primary outcome, patient preparedness, was measured at the postoperative visit on a 5-point Likert scale using the Patient Preparedness Questionnaire. A predetermined equivalence margin of 20% was chosen based on clinical judgment. Two 1-sided tests for equivalence were used for the primary and secondary outcomes. A total of 120 women were randomized. The study was ended early because of COVID-19 and subsequent cancellations of surgery. Of the randomized patients, 85 had primary outcome data (43 offices, 42 phones). Mean age of patients was 62.0 (SD, 1.0) years; 64 (75.3%) had stage III or IV prolapse. The primary outcome, patient preparedness at the postoperative visit, was equivalent in the 2 groups (office, n = 42 [97.7%]; phone, n = 42 [97.6%]; P < 0.001; 95% confidence interval, -0.10 to 0.10). Most women expressed preference for a phone call (n = 66 [65.5%]). More women in the phone group preferred a phone call (phone: 90.5% vs office: 40.5%; P < 0.001). Overall, nearly all women (96.5%) were satisfied with their choice of counseling method. This study demonstrates that a phone call is equivalent to an office visit for patient preparedness before POP surgery, suggesting that telehealth modalities should be considered an option for preoperative patient counseling. The results are consistent with the growing body of literature in support of telehealth from both a feasibility and patient preference standpoint. Future studies should investigate patient attitude toward and acceptance of preoperative video visits.