Preoperative patient education is a key element of the surgical experience.  Studies have shown patients undergoing surgery for pelvic organ prolapse (POP) are often not adequately informed about their condition and procedure. Our objective was to characterize the methods, resources, and content that urology and urogynecology providers employ for preoperative counseling.

A 73-item survey containing provider demographics, patient education methods, resources, content, and provider communication techniques was created using REDCap. The survey link was distributed via email, Twitter, and Facebook inviting attending physicians, trainees, physician assistants, nurse practitioners and nurses who treat POP were invited to participate in the survey. Providers who counseled <6 patients/year were excluded.

We received a total of 38 responses from our first phase of distribution for a response rate of 12% (38/313). We received another 65 responders from the second phase, though the denominator for this phase was unknown. Therefore, a total of 103 respondents completed our survey. Fourteen participants were excluded because they did not annually counsel at least six patients. Therefore, a total of 89 surveys were included in final analysis.  
The majority of respondents were attending physicians (n=77). There were a few physician assistants (n=6) and trainees (n=5), and one nurse practitioner. Approximately two-thirds of respondents were female. Provider age ranged from 29 years of age to 67 with a mean of 44 ± 9 years. Half of the providers were less than 10 years out from training, and the majority worked in either urban teaching hospitals (64%) or group private practices (23%). Our respondents reported counseling anywhere from 7 to 600 patients undergoing pelvic organ prolapse surgery per year with a mean of 100 ±101. Most providers (78%) reported their patient population to have a mix of government or commercial insurance, and estimated the health literacy of their patient populations as either fair (43%) or good (42%). Respondents spent an average of 31 ± 19 minutes counseling their patients. Counseling times ranged from 10 to 120 minutes. 
The most common primary in-office method of patient education was through personal interview (78%), or speaking directly to the patient. Other reported primary methods included the use of drawn or printed illustrations (n=10), using print materials such as brochures (n=9). One provider used models or props. Standardized print materials, drawn or printed illustrations, models or props, and websites were commonly used supplemental methods. The International Urogynecological Association was the most common source for print materials, used by half the providers that utilized print materials. Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU), American Urogynecologic Society (AUGS) and International Continence Society (ICS), were other popular sources. For those who referred patients to website (n=13), AUGS and SUFU were the most common. Few providers used instructional videos (n=4) or smartphone applications (3); however, when used, YouTube and the AUGS POP- Q Interactive Assessment Tool were the most popular, respectively.
All providers reported that they counseled women on the anatomy of POP, observation as a treatment option, and the use of native tissues during surgery. The majority of providers discussed various surgical approaches (99%), causes of pelvic organ prolapse (98%), the postoperative hospital course (98%), pessary as a treatment (95%), management of the uterus when applicable (95%), use of a Foley catheter postoperatively (95%), and the patients’ own role in recovery after surgery (95%). Fewer providers reported including the use of mesh (88%), pelvic floor physical therapy as a treatment option (84%), and postoperative use of analgesia (82%). Less than half (46%) discussed the use of biologics in surgery. 
We asked whether complications were discussed in detail, mentioned or not discussed in the preoperative counseling. Mesh complications, when applicable, (68%), urinary incontinence (66%), and need for repeat surgery (52%) were discussed in detail by the most providers. Urinary retention, injury to surrounding structures, storage lower urinary tract symptoms, dyspareunia, bleeding, infection and constipation were mentioned by more providers than they were discussed. A substantial number of providers neither discussed nor mentioned constipation (17%) or dyspareunia (12%) as potential complications. 
When asked about communication techniques used when counseling patients for POP, most providers reported using simple language (95%), giving their patients printed materials (87%), using illustrations (87%), and speaking slowly (80%) most or all the time. Very few providers routinely followed up with patients by telephone (11%) or asked patients how they learned best (10%). Seventeen responders (20%) stated that they ask patients to provide evaluation or feedback for the counseling they received.

Our data revealed that a personal interview, where the provider is simply speaking to the patient, is the most common method of delivering preoperative patient education. Many providers supplemented a personal interview with instructions, illustrations, models, and references to websites or other materials. Providers seem to be thorough in explaining the condition of POP, the treatment options, and what can be expected after surgery. However, many providers reported that they only mention rather than discuss some common complications of POP surgery, or do not mention at all like dyspareunia. Our respondents reported using a variety of communication techniques to convey their counseling.

POP education is most often completed by personal interview supplemented by standardized print material and drawn or printed illustrations. Providers cover many POP topics in counseling, but do not detail many complications.