Patient-Centered Versus Physician-Centered Counseling MidUrethral Sling Videos

Management of Pelvic Floor Disorders (PFDs) is individualized according to a patient's
symptomatology and quality of life. Although conservative measures exist, patients may elect
for surgical management. The decision making process for surgery is complex. It is well
documented that patient's lack understanding prior to their surgical procedures. Preparedness
for MUS surgery is related to a patient's comprehension of the purpose, risks, benefits, and
complications. Patients who are more prepared prior to surgery have been proven to have
greater postoperative satisfaction. Therefore, it is essential to improve patients'
preparedness and enhance patients' understanding of realistic expectations of post-operative
outcomes.

The investigators long-term goal is to improve patient-centered preparedness and satisfaction
when considering surgery. Previous studies by the Preliminary Study of Peer Support Groups
and Pelvic Floor Disorders have demonstrated trends in improvement for preparedness and
decision conflict with the use of peer focus groups. However, peer support groups are a
costly process and there may be many barriers to participation.

A key gap in the literature is how to improve patient preparedness for surgery and improve
satisfaction through the use of peer counseling in a manner that is convenient for patients,
reproducible and low cost. Technological advances with multimedia may assist in bridging this
gap. With ease-of-access to mobile electronic devices, videos are effective tools to prepare
patients for surgery. The purpose of this randomized controlled clinical trial is to
determine if a patient-centered video improves satisfaction and preparedness compared to a
physician-centered video.

The first objective of this research is to develop two videos to counsel patients who have
elected to undergo a MUS procedure. One video will be created from a physician-centered
approach. The second video will be a patient-centered perspective. The second objective of
this research is to compare the impact of video counseling between women randomized to a
physician-centered versus a patient-centered video. The central hypothesis is that women
randomized to a patient-centered video will report higher scores of satisfaction and
preparedness than women randomized to the physician-centered video.

Specifically, our aims for this study are:

1. To create two videos to be used to counsel patients who have elected to undergo a MUS
procedure. One video will present the risks, benefits and alternatives to MUS surgery by
a physician, mimicking traditional counseling prior to surgery. The second video will
explain the risks, benefits and alternatives to the MUS surgery utilizing a patient
mentor who has undergone the MUS procedure and will describe the patients' perception of
the information. The patient-centered video will also include topics that have
previously been identified by focus groups as important patient-centered aspects of
pre-surgical counseling.

2. To compare the impact of video counseling between women randomized to a
physician-centered video and a patient-centered video. Hypothesis: Women randomized to a
patient centered-video will report higher satisfaction and preparedness as measured by
validated scales. They will have higher scores on the Post-operative preparedness
questionnaire (PPQ), Preparedness Scale and the Surgical Decision Satisfaction (SDS-PFD)
questionnaire; and lower scores on the Decision Regret Scale (DRS-PFD) questionnaire
than women randomized to view the physician-centered video prior to undergoing
mid-urethral sling surgery.

3. To compare a women's decisional conflict post-operatively in women randomized to the
physician-centered video and the patient-centered video. Hypothesis: There is a
reduction of decisional conflict in women randomized to the patient-centered video.

4. To determine if there are differences in anxiety scores in women who watch the
patient-centered video versus the physician centered video. Hypothesis: Anxiety scores
measured by the State Trait Anxiety Inventory (STAI: Y-6 Item) questionnaire are
decreased by a pre-operative patient-centered counseling video.

Inclusion Criteria:

1. Subjects are ≥ 18 years of age

2. Planning to undergo a midurethral sling procedure

3. Either stress urinary incontinence (SUI) or mixed urinary incontinence (MUI) with a
positive cough stress test or SUI documented on urodynamic testing

4. English speaking

Exclusion Criteria:

1. Those who desire a concomitant POP Surgery

2. Inability to speak/understand English

3. Prior midurethral sling performed