Fear, Shame, and Miscommunication: A Qualitative Study on Treatment Choice for Pelvic Organ Prolapse

Introduction and Hypothesis:

Pelvic organ prolapse (POP) negatively impacts the quality of life of many women. Effective treatment options include the use of a pessary and surgery. This study was aimed at exploring the facilitators and barriers influencing decision-making between pessary and surgical treatment from both the patients' and gynecologists’ perspectives. 

Methods:

This qualitative study involved semi-structured interviews with 14 women from the own choice cohort in the PEOPLE study and 12 gynecologists from various hospitals throughout the Netherlands. Participants were purposively sampled to capture a range of experiences and professional backgrounds. The women varied in age and prolapse severity and had differing experiences with both pessary use and surgery, whereas gynecologists represented a mix of junior and senior specialists from academic and regional hospitals. Interviews were conducted until thematic saturation was reached. Data were analyzed using thematic analysis following Braun and Clarke. 

Results: 

Three main themes emerged. Treatment goals were a reflection of fears and misconceptions, illustrating the reasons behind women’s treatment choices; patient presentation delay as a result of ignorance and shame, addressing the societal taboos surrounding POP; and consultation at the gynecologist with communication gaps and decision-making challenges, highlighting the barriers faced during consultations with gynecologists.

Conclusions: 

Optimal decision-making can be limited because of a lack of knowledge among the general population, patients, and general practitioners. Ignorance and feelings of fear and shame on the subject in patients further hinder the decision-making process. Addressing these barriers could improve the shared decision-making process and enhance patient satisfaction with their chosen treatment.