Hypothesis / aims of study
Ethical patient care and good medical practice aims to promote patient autonomy, shared decision making and informed consent. Informed consent begins with the giving of information often as a verbal discussion which may be supplemented by additional written information or signposting to the appropriate information source. The discussion should include the risks and benefits of an intervention and what alternatives are available. The process ends with the giving of consent assuming the patient has the capacity to understand the information, retain the information and weigh the information to communicate a decision. For surgical procedures, a signature on a consent form serves as evidence for consent.
Pelvic organ prolapse has a likely prevalence of 25-35% of women with a lifetime risk of surgical intervention at 11-19% [1-3]. The aim of this study was to assess a woman’s understanding of surgical risks for vaginal prolapse surgery not utilising mesh.
Study design, materials and methods
An electronic questionnaire was created using the Qualtrics platform. The questionnaire began with an introduction about vaginal prolapse and its treatment options including no treatment, pelvic floor muscle training, a vaginal pessary or vaginal surgery. This was followed by further information on vaginal prolapse surgery such as operation recovery, operation methods and the short and long term complications.
The information provided to women was taken from validated and peer reviewed publications by the Royal College of Obstetricians and Gynaecologists consent advice as well as the British Society of Urogynaecology patient advice leaflets. Website links to additional information was embedded in the questionnaire for women to review. After reviewing this information, women were asked if they would like to continue to complete an anonymous questionnaire. Ten questions were presented to focus on the woman’s understanding of the risks of the surgery.
The questionnaire link was circulated to women aged over 18 years with no professional gynaecology knowledge by email or using instant messaging methods.
Interpretation of results
Most responders reported that they understood the presented surgical risks of vaginal prolapse surgery. However when ‘tested’ only 19% (12/63) answered all the questions correctly suggesting an incomplete understanding. Conversely those who did not understand the risks answered the questions well, suggesting a lack of confidence in their understanding.
The three questions most commonly answered incorrectly concerned the risk of serious complication with bowel injury, the appearance of the genitalia post-operatively and understanding the realistic success of the operation. Furthermore different age groups may place increased value on different risk elements such as impact to fertility, cosmetic outcome and risk versus the actual benefit.