Study design, materials and methods
This multicentre prospective service evaluation examines a video comparing the advantages and disadvantages of four common SUI procedures (bulking agent injection, colposuspension, tissue sling, and mid-urethral mesh tape). Developed by a urogynaecology multidisciplinary team, the video followed a co-creation approach and was based on the comparison table of the validated 2019 SUI Patient Decision Aid (SUI-PDA) leaflet (1). Participants reviewed the procedure information leaflets before watching the video in clinic or at home, reflecting real-world use.
Patients from three teaching hospitals, along with healthcare professionals, evaluated the video using the DISCERN tool to assess information “Reliability” and “Quality” (2). Patients also completed the Decisional Conflict Scale (DCS) before and after viewing the video (3). Total DCS scores and subscale scores (“informed”, “values clarity”, “support”, “uncertainty”, and “effective decision”) were analysed alongside treatment preferences.
Results
Data were collected over a 36-month period (2022–2025). A total of 61 participants were included, comprising 45 patients and 16 healthcare professionals. The average age of patient respondents was 55.6 years (SD 10.49).
DISCERN scores were high across both groups, with mean scores >84% for information quality and >90% for reliability (Table 1). There was no significant difference between patients and healthcare professionals in their assessment of reliability or information quality. (Table 1).
A total of 43 patients completed pre-video DCS and 42 completed post-video DCS. Mean total DCS score decreased (i.e. less decisional conflict) significantly from 20.6 (SD 16.31) pre-video to 9.2 (SD 10.08) post-video (paired t=6.309, n=41, p<0.001), representing a clinically meaningful mean reduction of 11.4 points. Significant reductions were observed across all DCS subscales (p<0.001) (Table 2).
Among 38 women who reported treatment preferences before and after viewing the video, 12 (31.6%) changed their decision, most commonly from “unsure” to urethral bulking injection. Women who changed their decision were significantly younger than those who did not (mean 49.4 vs 56.8 years, F=4.941, p=0.033) and showed a greater reduction (less decisional conflict) in the DCS “informed” subscale (mean reduction 20.8 vs 8.0, F=8.417, p=0.006). Only four (9.3%) women demonstrated increased decisional conflict following the video.
There was no significant correlation between patients’ DISCERN and DCS scores, indicating that higher perceived video quality was not associated with greater reductions in decisional conflict. Similarly, DISCERN scores did not differ significantly between women who changed their treatment choice and those who did not.
Interpretation of results
To our knowledge, this study is the first to validate video-animated information for women considering surgery for SUI. The SUI-PDA video significantly reduced decisional conflict across all domains, supporting its role in shared decision-making, particularly in the context of post-mesh era uncertainty. Approximately one-third of women changed their treatment preference after viewing the video, indicating facilitation of decision-making. Younger women were more likely to change decisions, demonstrating greater responsiveness to decision aids. The lack of association between DCS and DISCERN suggests that decision-making may be driven by accessible, structured information rather than perceived video quality. Notably, the brief, scalable video format represents a key innovation, with women reporting the video as helpful through high DISCERN scores regardless of changes in confidence or treatment choice.