Short summary

In the Pelvic Floor Center (PFC) at HSJ, patients participate in a interprofessional shared consultation (ISC), where clinicians from several different specialties are present and where patient and clinician together decide which examinations and treatment should be initiated. The decision-making process is based on shared decision-making.

There is a lack of knowledge about how patients experience this way of practice consultations.

Rationale

Patients, health professionals and politicians want patients to be more involved in their own examination and treatment process. Back in 2015, the Danish Regions thus presented a joint plan for the hospital system, which should make the meeting between citizens and the health service more person-centred.

With Shared Decision-makeing (SDM), the healthcare professional (e.g. doctor, nurse or physiotherapist) conveys relevant and for the patient comprehensible knowledge based on available evidence about diagnosis, prognosis, examinations, treatment options and risks to the patient.

In 2019, Region Southern Denmark and the region's hospitals began strategic work with the implementation of the FBT method.

FBT is also relevant for patients with pelvic floor disorders. The different kinds of pelvic floor symptoms can have several causes, and often several treatment measures must be implemented to alleviate the symptoms and improve the quality of life for the patient.

The complex issues of this patient group can thus risk turning the patient into several consultation in different specialties, with risks of an investigation and treatment process without any shared coordination. This risks not only negatively affecting the patient's benefit and experience of the meeting with the healthcare system, but can also lead to a waste of time and resources for all parties.

In 2018, it was decided regionally that HSJ should establish an interdisciplinary centre for incontinence and sexual dysfunction: the Pelvic Floor Centre at HSJ strives to be a regional beacon within patient-centred investigation and treatment across several specialties and professional groups and for national inspiration.

When patients with two or more of the aforementioned diagnoses are referred by their own doctor or specialist to the PFC at HSJ, the patient is first offered an investigative examination and interview in a shared consultation, where specialists covering the following subspecialties/specialist areas are present: Urogynaecologist, urologist, proctologist, specially trained physiotherapist, continence nurse and clinical sexologist.

In the shared consultation with the patient, the connection between the problems is revealed, and the patient's preferences for investigation and treatment are revealed. During the consultation, the starting point is the problems that the patient himself finds important. A moderator facilitates that the patient is included in the dialogue and that the SDM method is used.

Organizing shared consultations is not yet a widespread method of organizing investigation and treatment of patients with pelvic floor diagnoses. There has therefore not yet been research, either nationally or internationally, into how this type of patient experiences a joint consultation.

The literature review shows that the vast majority of patient groups want involvement in their own patient process. However, there are also not clear and contradictory results. It is therefore relevant to examine the area in the existing context focused on SDM among pelvic floor patients.

The purpose of this study is therefore to examine the patients' experience of involvement in the decision-making process regarding examination and treatment in the shared consultations.

Description of the cohort

The study takes place at the PFC at the HSJ, Denmark.

The inclusion of 20-24 patients who have been treated at PFC at HSJ is planned. The decision on the number included is guided by reflections in relation to the concept of information power in order to achieve the purpose of the study.

The informants are recruited when he/she participate in a ISC. A member of the project group (moderator) who participates in the ISC at PFC HSJ, together with other team members, assesses whether the patient is suitable to participate in the study.

If the patient meets the selection criteria, the moderator will invite the patient to participate in the study. The patient will be informed orally and in writing about the study, and there will be an opportunity to ask questions about the study. The patient is then given time to reflect.

The patient will be called within a week by the project manager for final clarification as to whether he/she wishes to participate in the study. On the same occasion, it is planned where and when a possible interview can take place. The project manager, which is not part of the joint consultations and PFC HSJ, conducts the interviews.

Before participating in the project, the patient gives written consent and receives a copy of the signed declaration of consent. The patient will be informed orally and in writing about the study.

Data and biological material

The empirical data is collected from December 2022 - March 2022 and is generated via semi-structured interviews with patient's (+/- 2 week) after participation in a interprofessional shared consultation. The interviews are recorded on a digital audio recorder and subsequently transcribed.

Data is stored in OPEN, Odense University Hospital and thus complies with the data protection ordinance.

The software program NVivo will be used for transcription as well as to systematize data. Data will be deleted after the project is completed.

The transcribed interviews are analyzed using qualitative content analysis. The qualitative content analysis starts inductively, in order to approach the text openly and unconditionally. The analysis includes both a manifest (descriptive) level and a latent (interpretive) level. In order to gain an understanding of what is said in the text, patterns and variations of the patients' experiences are identified, which emerge intersubjectively.

The informants are informed orally and in writing about the project before signing the consent form. It is emphasized to the informants that consent can be withdrawn without justification and that it will not have consequences for their further course.

The project is registered in a list of research projects of the Region of Southern Denmark. The Regional Science Ethics Committee has assessed that the study is not subject to notification.

Data of all kinds are handled and stored in accordance with the Data Protection and Regulation.