Female Pelvic Medicine & Reconstructive Surgery:
1Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL; 2Obstetrics and Gynecology, Bruce and Ruth Rappaport, Technion Faculty of Medicine, Rambam Health Care Campus, Haifa, Israel
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Linda Brubaker:Allergan:Research Funding:Investigator;Pfizer:Research Funding:Investigator;Pfizer:Honorarium:Research Consultant
We aimed to evaluate the relationship between patients' dispositional optimism and symptoms of pelvic floor dysfunction and to determine whether optimism can predict patient decisions regarding treatment of pelvic floor disorders.
MATERIALS AND METHODS:
We prospectively recruited consecutive women presenting to Loyola's Urogynecology Center for treatment of pelvic floor disorders to this cohort study. In addition to demographic information and urogynecologic history and exam, all women completed the short form of the Pelvic Floor Distress Inventory (PFDI-20) and the Life Orientation Test-Revised (LOT-R). The LOT-R is a validated questionnaire that evaluates people's general disposition or level optimism. Participants were also asked to list their goals for treatment prior to the 1st visit. For analysis, participants with LOT-R scores below the median were classified as “pessimists” and women with LOT-R above the median were classified as “optimists”. Patient's goals were categorized into 5 groups: symptom resolution, treatment specific to pelvic floor disorders, quality of life improvement, furthering of emotional well-being, and information gathering. The chi-square test of association was used to compare nominal data, while the Mann-Whitney test was used to compare independent groups of continuous data.
The study included 467 women: 44% pessimists and 56% optimists. Pessimists and optimists did not differ by age (P = 0.28), parity (P = 0.81), POP-Q stage (P = 0.86), presenting clinical diagnoses (P = 0.68) or urodynamic diagnoses (P = 0.5). Pessimists listed a higher number of treatment goals than optimists (2 vs. 1, P < 0.01). Pessimists' goal were more likely to be less specific and aimed at quality of life improvement (P < 0.02), while optimists' goals were more likely to be aimed at resolution of specific symptoms (P = 0.78). Pessimistic and optimistic patients reported similar bother from pelvic floor symptoms, scoring comparably on the UDI (P = 0.73), POPDI (P = 0.77), and CRADI (P = 0.58). Dispositional optimism did not affect treatment choice; pessimists were as likely to choose surgery as optimists; however, optimists were more likely to be sexually active (56% vs 36%, P < 0.001).
Dispositional optimism is not associated with differences in perception of pelvic floor symptoms or treatment choices in women seeking treatment for pelvic floor disorders. Pessimistic women were as likely as optimists to elect surgical treatment for their pelvic floor disorder. However, pessimists listed more treatment goals which tended to be more vague, emphasizing general improvement in quality of life, rather than resolution of specific symptoms.