Patient-centered goals for pelvic floor dysfunction surgery: What is success, and is it achieved?

OBJECTIVE: The purpose of this study was to describe patient-identified goals for pelvic floor dysfunction surgical procedures and patient-reported achievement of those goals. STUDY DESIGN: Thirty-three consecutive patients scheduled for pelvic floor dysfunction surgical procedures completed a preoperative questionnaire on which they listed up to 5 personal goals for surgical outcomes. At 6- and 12-week follow-up, patients reported the degree (rated 1-5) to which each goal had been met (1 = strongly disagree that the goal was met; 5 = strongly agree). Age, race, vaginal parity, previous pelvic surgical procedures, pelvic floor dysfunction diagnosis, pelvic floor dysfunction surgical procedure, and peri-operative complications were also recorded. Goals were categorized as being primarily related to symptom relief, increasing activity, general or other health concerns, social relationships and self-image, or physical appearance. Rates of self-reported goal achievement at 6 and 12 weeks were calculated, and differences in the proportion of goals achieved by category were assessed. RESULTS: Women reported a mean of 3.6 goals; 24 of 33 women (72.7%) listed greater than or equal to4 goals. Of the 119 goals listed, 51 goals (42.9%) dealt with urinary or bowel symptoms; 36 goals (30.3%) dealt with improving activity; 15 goals (12.6%) dealt with general health concerns; 14 goals (11.8%) dealt with social relationships and self-image, and 3 goals (2.5%) dealt with physical appearance. Twenty-seven of the 33 women (81.8%) listed symptom relief; 22 women (66.7%) listed at least 1 activity-related goal; 14 women (42.4%) listed general or longer term health, and 11 women (33.3%) listed a social or self-image goal. Of the 119 goals listed, women agreed or strongly agreed that 88 goals (73.9%) were met at 6 weeks, and 101 goals (84.9%) were met at 12 weeks (chi(2) = 3.7 for difference between proportion at 6 and 12 weeks; P = .054). At 6 weeks, women agreed or strongly agreed that most goals had been met for activity, symptoms, general health, and appearance, but not for social/self-image goals (chi(2) = 24.9; P < .001). However, by 12 weeks, women agreed or strongly agreed that most goals had been met in all categories. CONCLUSION: Women who undergo pelvic floor dysfunction surgical procedures have a variety of desired subjective outcomes. Goals that relate to social roles, sexuality, and self-image may take longer to successfully achieve than other types of goals. Longer-term follow-up is crucial to determine whether initial improvements have been maintained. Assessment of patient goals is quick and easy and may help clinicians better understand and care for their patients.