Claudia Sevilla

Patients' understanding of pelvic floor disorders: what women want to know.

Objective To assess the effect of initial visit with a specialist on disease understanding in women with pelvic floor disorders. Methods Women with referrals or chief complaints suggestive of urinary incontinence or pelvic organ prolapse were recruited from an academic urology clinic. The patients completed a Test of Functional Health Literacy in Adults and scripted interview sessions before and after a physician encounter. Physician’s treatment plans were standardized based on diagnosis and were explained using models. Interview transcripts were analyzed using qualitative grounded theory methodology. Results Twenty women with pelvic floor disorders (urinary incontinence or pelvic organ prolapse) were recruited and enrolled in this pilot study. The mean age was 60.5 years (range, 31–87 years) and most of the women were white, with a college degree or beyond. Test of Functional Health Literacy in Adults scores indicated adequate to high levels of health literacy. Preliminary themes before and after the physician encounter were extracted from interviews, and 2 main concepts emerged. First, after the initial physician’s visit, knowledge of their diagnosis and the ability to treat their symptoms relieved the patients’ concerns related to misunderstandings of the severity of their disease, Second, the patients tended to focus on treatment and had difficulty grasping certain diagnostic terms. This resulted in good understanding of treatment plans despite an inconsistent understanding of diagnosis. Conclusion Our findings demonstrated a significant effect of the initial physician’s visit on the patients’ understanding of their pelvic floor disorder. Despite the variation in diagnostic recall after the physician encounter, the patients had a good understanding of treatment plans. This served to increase perceived control and adequately relieve patients’ fears.

Patterns of Management of Urethral Stricture Disease in the Veterans Affairs System

OBJECTIVES To describe the number of urethral dilations, urethrotomies, and urethroplasties performed on men with a diagnosis of urethral stricture disease seeking care in the Veterans Affairs (VA) health care system in southern California and southern Nevada over a 5-year period. To date, few health services research studies have evaluated patterns of care for urethral stricture disease using national datasets. METHODS We analyzed stricture treatment for male veterans with an ICD-9 diagnosis code for urethral stricture in the National Patient Care Database (NPCD). Encounters for urethral stricture procedures performed were identified based on the presence of Physicians Current Procedural Terminology Coding System (4th edition, CPT-4) codes for treatments performed during the fiscal years 2002-2006. RESULTS A total of 1457 men carried a diagnosis of urethral stricture disease during the index time period. Of these, 333 men (23%) underwent 431 procedures. Of the 216 men who underwent urethral dilations, 170 (79%) underwent only 1 procedure and 26 (12%) underwent 2 procedures. Of the 79 men who underwent urethrotomy, 76 (96%) underwent 1 procedure. Sixteen men (5%) underwent a urethroplasty, 8 of whom underwent a perineal urethrostomy. CONCLUSIONS The vast majority of men treated for stricture disease underwent only 1 such procedure over a 5-year time period. Further research is required to investigate whether this is a quality-of-care issue or patients refusing intervention. It is possible that some patients may be temporized for a significant period with dilation/urethrotomy, whereas those with rapid recurrence require early urethroplasty.

Prevalence and correlates of urinary incontinence among older community-dwelling women.

Objectives As the aging population in the United States grows, the investigation of urinary incontinence (UI) issues becomes increasingly important, especially among women. Using data from the California Health Interview Survey (CHIS), we sought to determine the prevalence and correlates of UI among an ethnically diverse population of older community-dwelling women. Methods A total of 5374 female Californians aged 65 years or older participated in a population-based, cross-sectional random-digit-dialing telephone survey. The CHIS 2003 adult survey included 1 question for Californians aged 65 years or older about UI. Additional information collected via the self-reported survey included demographics (age, race/ethnicity, education, and household income), general health data (self-reported health status, height and weight, fall history, and special equipment needs), medical comorbidities, and health behaviors (tobacco use, physical activity, and hormone replacement therapy). Results The estimated statewide female prevalence rate for UI was 24.4%. Prevalence rates increased with age. Urinary incontinence was significantly associated with poorer overall health (adjusted odds ratio [OR], 3.43; P < 0.001), decreased mobility (OR, 1.81; P = 0.004), current use of hormone replacement therapy (OR, 1.72; P < 0.001), being overweight or obese (OR, 1.60; P < 0.001), a history of falls (OR, 1.53; P = 0.002), and a history of heart disease (OR, 1.38; P = 0.010). After adjusting for all health factors, UI was not found to have any significant association with the level of education, household poverty status, or smoking status. Conclusions Urinary incontinence prevalence among this diverse group of older community-dwelling Californian women parallels that of other population-based studies. The CHIS demonstrated that poor health, increased BMI, falls, and decreased mobility are strongly correlated with UI.

Communication barriers among Spanish-speaking women with pelvic floor disorders: lost in translation?

Objectives The purpose of our study was to evaluate barriers in communication and disease understanding among office staff and interpreters when communicating with Spanish-speaking women with pelvic floor disorders. Methods We conducted a qualitative study to evaluate barriers to communication with Spanish-speaking women with pelvic floor disorders among office staff and interpreters. Sixteen office staff and interpreters were interviewed; interview questions focused on experiences with Spanish-speaking patients with pelvic floor disorders in the clinic setting. Interview transcripts were analyzed qualitatively using grounded theory methodology. Results Analysis of the interview transcripts revealed several barriers in communication as identified by office staff and interpreters. Three major classes were predominant: patient, interpreter, and system-related barriers. Patient-related barriers included a lack of understanding of anatomy and medical terminology and inhibited discussions due to embarrassment. Provider-related barriers included poor interpreter knowledge of pelvic floor vocabulary and the use of office staff without interpreting credentials. System-related barriers included poor access to information. From these preliminary themes, an emergent concept was revealed: it is highly likely that Spanish-speaking women with pelvic floor disorders have poor understanding of their condition owing to multiple obstacles in communication. Conclusions There are many levels of barriers to communications with Latin women treated for pelvic floor disorders, arising from the patient, interpreter, and the system itself. These barriers contribute to a low level of understanding of their diagnosis, treatment options, and administered therapies.

Pelvic organ prolapse: a disease of silence and shame.

Objectives The objectives of this study are to better understand women’s experience with pelvic organ prolapse (POP) and to compare this experience between English-speaking and Spanish-speaking women. Methods Women with POP were recruited from female urology and urogynecology clinics. Eight focus groups of 6 to 8 women each were assembled—4 groups in English and 4 in Spanish. A trained bilingual moderator conducted the focus groups. Topics addressed patients’ perceptions, their knowledge and experience with POP symptoms, diagnostic evaluation, physician interactions, and treatments. Results Both English-speaking and Spanish-speaking women expressed the same preliminary themes—lack of knowledge regarding the prevalence of POP, feelings of shame regarding their condition, difficulty in talking with others, fear related to symptoms, and emotional stress from coping with POP. In addition, Spanish-speaking women included fear related to surgery and communication concerns regarding the use of interpreters. Two overarching concepts emerged—first, a lack of knowledge, which resulted in shame and fear and second, public awareness regarding POP is needed. From the Spanish speaking, an additional concept was the need to address language barriers and the use of interpreters. Conclusions Both English-speaking and Spanish-speaking women felt ashamed of their POP and were uncomfortable speaking with anyone about it, including physicians. Educating women on the meaning of POP, symptoms, and available treatments may improve patients’ ability to discuss their disorder and seek medical advice; for Spanish-speaking women, access to translators for efficient communication is needed.

Communication between physicians and Spanish-speaking Latin American women with pelvic floor disorders: a cycle of misunderstanding?

Objective This study aimed to assess the effect of the initial visit with a specialist on disease understanding among Spanish-speaking women with pelvic floor disorders. Methods Spanish-speaking women with referrals suggestive of urinary incontinence (UI) and/or pelvic organ prolapse (POP) were recruited from public urogynecology clinics. Patients participated in a health literacy assessment and interview before and after their physician encounter. All interviews were analyzed using Grounded Theory qualitative methods. Results Twenty-seven women with POP (n = 6), UI (n = 11), and POP/UI (n = 10) were enrolled in this study. The mean age was 55.5 years, and most women had marginal levels of health literacy. From our qualitative analysis, 3 concepts emerged. First, was that patients had poor understanding of their diagnosis before and after the encounter regardless of how extensive the physician’s explanation or level of Spanish-proficiency. Second, patients were overwhelmed with the amount of information given to them. Lastly, patients ultimately put their trust in the physician, relying on them for treatment recommendations. Conclusions Our findings emphasize the difficulty Spanish-speaking women with low health literacy have in understanding information regarding pelvic floor disorders. In this specific population, the physician has a major role in influencing patients’ treatment decisions and helping them overcome fears they may have about their condition.

Misconceptions and miscommunication among Spanish-speaking and English-speaking women with pelvic organ prolapse

Introduction and hypothesisLimited data exist on women’s experience with pelvic organ prolapse (POP) symptoms. We aimed to describe factors that prevent disease understanding among Spanish-speaking and English-speaking women.MethodsWomen with POP were recruited from female urology and urogynecology clinics in Los Angeles, California, and Albuquerque, New Mexico. Eight focus groups were conducted, four in Spanish and four in English. Topics addressed patients’ emotional responses when noticing their prolapse, how they sought support, what verbal and written information was given, and their overall feelings of the process. Additionally, patients were asked about their experience with their treating physician. All interview transcripts were analyzed using grounded theory qualitative methods.ResultsQualitative analysis yielded two preliminary themes. First, women had misconceptions about what POP is as well as its causes and treatments. Second, there was a great deal of miscommunication between patient and physician which led to decreased understanding about the diagnosis and treatment options. This included the fact that women were often overwhelmed with information which they did not understand. The concept emerged that there is a strong need for better methods to achieve disease and treatment understanding for women with POP.ConclusionsOur findings emphasize that women with POP have considerable misconceptions about their disease. In addition, there is miscommunication during the patient–physician interaction that leads to further confusion among Spanish-speaking and English-speaking women. Spending more time explaining the diagnosis of POP, rather than focusing solely on treatment options, may reduce miscommunication and increase patient understanding.

The pessary process: Spanish-speaking Latinas’ experience

Introduction and hypothesisLittle is known about women’s experience with conservative management of pelvic organ prolapse. We sought to understand the experiences of Spanish-speaking women who choose a pessary.MethodsSpanish-speaking women from a urogynecological pessary clinic were recruited for this study. Interviews were conducted and the women were asked about their pessary experience including questions involving symptom relief, pessary management, and quality of life. All interview transcripts were analyzed using the qualitative methods of grounded theory.ResultsSixteen Spanish-speaking women who had been using a pessary for at least 1 month were enrolled in this study. Grounded theory methodology yielded several preliminary themes, in which one major concept emerged as a pessary adjustment process. In this process patients had to first decide to use a pessary, either because of physician’s recommendations or out of personal choice. Second, the patients entered an adjustment period in which they learned to adapt to the pessary, both physically and mentally. Lastly, if the patients properly adjusted to wearing a pessary they experienced relief of bothersome symptoms.ConclusionsOur findings demonstrate that Spanish-speaking women go through a process in order to adjust to a pessary. Furthermore, the physician plays a major role in not only determining a woman’s decision to use a pessary, but also whether she can adjust to wearing the pessary. This process is most successful when patients receive comprehensive management from a healthcare team of physicians and nurses who can provide individualized and continuous pessary care.