Hypothesis / aims of study
Pre-visit intake questionnaires are increasingly showing usefulness in multidisciplinary pelvic health care to streamline evaluation and capture complex symptom profiles. However, their impact on patient experience and trust in care remains unclear. It is the authors’ experience that patients felt more confidence in care knowing we were “asking the right questions” and learned from aspects of the intake (e.g. questions about avoidance of bladder irritants). This study aims to assess whether a comprehensive pelvic health questionnaire improves patient impression of care delivery and trust in pelvic health.
Study design, materials and methods
A cross-sectional follow-up survey was sent to patients who had completed our pelvic health intake questionnaire prior to their initial visit with 1) subspecialized urology, urogynecology, genitourinary reconstruction and 2) multidisciplinary pelvic pain clinic. This questionnaire obtains HPI and responsive delivery of further history, prior treatment, review of systems, and validated measures regarding bladder, bowel, sexual function and pelvic pain based on branching logic and gender. Participants rated experience with the questionnaire including perceived Clinical Value, Length and Burden, and Usability according to a 5-point Likert scale (1=least positive, 5=most positive). Trust in physician was assessed using the abbreviated Wake Forest Trust in Physician Scale (WFTPS), which includes items assessing confidence in physician judgement and perceived reliability of care on a 5 point Likert scale1.
Scores for Length and Burden, Usability, and Clinical Value were calculated as the means of their respective items (three per category) and combined to form an Overall Questionnaire Impact (OQI) score. Associations between each domain and trust in physician were evaluated using Pearson correlation. Trust scores were compared between patients who recalled completing the questionnaire and those who did not using a two-sample t-test.
Results
A total of 113/608 respondents fully completed the survey (response rate 19.3%), of whom 64 (56.6%) recalled completing the questionnaire and 49 (43.4%) did not. Participants who recalled reported moderately positive perceptions of the questionnaire, with an OQI of 3.8 ± 0.81 on the scale of 1 to 5. Perceptions were similarly positive for Length and Burden (3.94 ± 0.94), Usability (3.83 ± 0.84) and Clinical Value (3.74 ± 0.99). Within the clinical value section, 72% patients reported they learned something from the questionnaire itself.
Trust in physician was high overall. Patients who recalled completing the questionnaire reported slightly higher trust scores compared to those who did not (4.19 ± 0.91 and 4.04 ± 0.80, not statistically significant p=0.30).
OQI and Questionnaire usability demonstrated moderate to strong positive correlations with trust in physician (r=0.51, p<8.1E-09 and r=0.59, p<4.8E-12, respectively), whereas Length and Burden showed a weaker association (r=0.35, p<0.0001). Perceived Clinical Value was not associated with trust (r=-0.06, p>0.5).
Interpretation of results
Respondents felt positively about the opportunity to provide a thorough history. Whereas recalling the experience of completing it did not correlate with higher trust in physician, the respondents, who had all completed the electronic intakes, overall had high trust. Furthermore, they saw the questionnaire as providing clinical value and learned from it.