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

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 (TM) application) would have a greater impact on patient satisfaction with understanding prolapse symptoms compared with standard counseling (SC). 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 (TM). Ninety participants were required to detect a 30 % difference in satisfaction with prolapse knowledge between the two groups. Ninety women were randomized to SC (n = 44) or SC with iPad (TM) (n = 46). At baseline, 47 % of women were satisfied with their understanding of bulge symptoms (50 % SC vs. 43.5 % SC with iPad (TM), 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 (TM), p = 0.5]. Baseline anxiety was high: 70 % (65.9 % SC vs. 73.9 % SC with iPad (TM), 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 (TM), p = 0.7). Counseling times were similar between groups (9.5 min., SC vs. 8.9 min., SC with iPad, p = 0.4). Interactive counseling was associated with increased patient satisfaction with understanding bulge symptoms and decreased anxiety whether a web-based tool was used or not.