Title: Pelvic organ prolapse and treatment decisions -Developing an online preference-sensitive tool to support shared decisions

Abstract

Female patients with urogenital prolapse and gynecologists need to take treatment decisions that are often unpredictable regarding impact on the future everyday lives of the patients. Shared decision-making (SDM) elicits patients preferences in order to share decisions and involve patients actively into the decision making process. The aim of this study was to develop a feasible IT-based instrument to support the dialogue and SDM between patients and gynecologists during consultations. The instrument should elicit and weight patients’ preferences and combine these with evidence into ranked treatment options that were presented during consultations. Methods: The study had a design of user‐ involving field research and a development phase using the contextual design method together with the participatory design technique of prompting cards. Observations, ten exploratory interviews and five workshops prompted for emotional stories and identified the users’ needs. Five additional workshops decided for evidence and best estimates for the instruments algorithm. The design process tested for usability of the instrument in an iterative process (Figure 1). Results: Data was collected from four Danish gynecology outpatient clinics. Content analysis led to important themes and 16 criteria for the home-based preference-sensitive questions. For the patients three themes emerged: 1) how the impact of symptoms on everyday life affected the need for relief, 2) their bodily perception and sex life and 3) their worries about the future (table 1). For gynecologists the different symptoms and their severity was a main theme. Conclusion: The study demonstrates how user involvement informed the prototyping process and how patients’ preferences could be included in the final prototype through an algorithm. The developed algorithm, the eliciting questions and a graphical presentation in the patient’s health record gave way to each patient’s individual preferences and her involvement in the decision-making process.