title: Increasing patient preparedness for sacral neuromodulation improves patient reported outcomes despite leaving objective measures of success unchanged.
abstract: OBJECTIVE
  We assessed how a group shared appointment influenced patient preparedness for sacral nerve stimulation for refractory overactive bladder and/or urge urinary incontinence. We also evaluated subjective and objective outcomes.
  
  
  METHODS
  Patients considering sacral nerve stimulation were prospectively enrolled and invited to attend a group shared appointment. This 75-minute presentation included a question and answer period with an implanting surgeon and an implanted patient. Control patients received standard office counseling. A patient preparedness questionnaire was completed after the group shared appointment or office counseling. Response to treatment was determined using the postoperative satisfaction questionnaire, Patient Global Impression of Improvement (PGI-I) and voiding diaries.
  
  
  RESULTS
  In our study 36 women with a mean ± SD age of 61 ± 15 years underwent sacral nerve stimulation. There was no significant difference in patient demographics between the 19 women who attended the group shared appointment and the 17 controls. Overall preparedness was greater in the shared appointment group (p = 0.043) with better understanding of the purpose of (p = 0.003) and alternatives to (p = 0.043) sacral nerve stimulation. Significantly more women in the shared appointment group than controls felt completely prepared (78.9% vs 29.4%, p = 0.003) and completely satisfied (78.9% vs 35.3%, p = 0.003) with sacral nerve stimulation as well as very much better (68.4% vs 17.6%, p = 0.002) according to the PGI-I. There was no difference between the groups in the number of women with a 50% or greater symptom reduction on voiding diary.
  
  
  CONCLUSIONS
  Participating in a group shared appointment before sacral nerve stimulation improved patient preparedness and perceived outcomes of treatment, although there was no difference in objective outcomes based on voiding diary.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. farzeenfiroozi@aol.com
authors.forename: Farzeen
authors.initials: F
authors.lastname: Firoozi
authors.forename: Bradley
authors.initials: B
authors.lastname: Gill
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ingber
authors.forename: Courtenay K
authors.initials: CK
authors.lastname: Moore
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Rackley
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
mesh_terms: D004599:Electric Stimulation Therapy / Q000523:psychology*; D005260:Female; D006126:Group Processes; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012447:Sacrum / Q000294:innervation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000628:therapy*
keywords: GSA; QOL; SNS; UUI; appointments and schedules; electric stimulation; group shared appointment; overactive; quality of life; sacral nerve stimulation; urge; urge urinary incontinence; urinary bladder; urinary incontinence