Randomized trial of a web-based tool for prolapse: Impact on patient understanding and provider counseling

Introduction and hypothesis: Effective patient/provider communication is important to ensure patient understanding, safety, and satisfaction. Our hypothesis was that interactive patient/provider counseling using a web-based tool (iPad™ application) would have a greater impact on patient satisfaction with understanding prolapse symptoms compared with standard counseling (SC). Methods: Women with complaints of seeing/sensing a vaginal bulge were enrolled in this randomized controlled trial. Participants completed pre- and postvisit Likert scale questionnaires on satisfaction with prolapse knowledge and related anxiety. After new patient histories and physical examinations, study participants were randomized to SC or SC with iPad™. Ninety participants were required to detect a 30 % difference in satisfaction with prolapse knowledge between the two groups. Results: Ninety women were randomized to SC (n=44) or SC with iPad™ (n=46). At baseline, 47 % of women were satisfied with their understanding of bulge symptoms (50 % SC vs. 43.5 % SC with iPad™, p=0.5). After counseling, 97 % of women reported increased satisfaction with understanding of bulge symptoms (p<0.0001), with no difference between groups [42/44 (95.5 %) SC vs. 45/46 (97.8 %) SC with iPad™, p=0.5]. Baseline anxiety was high: 70 % (65.9 % SC vs. 73.9 % SC with iPad™, p=0.4). After counseling, anxiety decreased to 30 % (p<0.0001), with improvement in both groups (31.8 % SC vs. 28.3 % SC with iPad™, p=0.7). Counseling times were similar between groups (9.5 min., SC vs. 8.9 min., SC with iPad, p=0.4). Conclusions: Interactive counseling was associated with increased patient satisfaction with understanding bulge symptoms and decreased anxiety whether a web-based tool was used or not.