Abstract
Introduction and hypothesis
During the COVID-19 pandemic, many surgical societies released guidelines that included cancellation of elective cases. The aim of this study was to better understand our patients’ perceptions of the severity of their pelvic floor disorders (PFDs) and to determine what factors influenced this perception. We also aimed to better understand who might be amenable to telemedicine visits and what factors influenced this decision.
Methods
This is a cross-sectional quality improvement study that included women at least 18 years of age diagnosed with a pelvic floor disorder being evaluated within a university Female Pelvic Medicine and Reconstructive Surgery clinic during the COVID-19 pandemic. Patients whose appointments and procedures were being cancelled were queried on whether they would be willing to answer a telephone questionnaire developed by the clinical and research teams. We gathered descriptive data from 97 female patients with PFDs using a primary phone questionnaire. The data were analyzed using proportions and descriptive statistics.
Results
Of the 97 patients, the majority (79%) viewed their conditions as non-urgent. Factors that influenced patients’ perception of urgency included race (p=0.037), health status (p≤0.001), a history of diabetes (p=0.011), and willingness to attend an in-person appointment (p=0.010). Further, 52% of respondents were willing to attend a tele-health appointment. Statistically significant factors influencing this decision were ethnicity (p=0.019), marital status (p=0.019), and willingness to attend an in-person appointment (p=0.011).
Conclusion
The majority of women did not view their conditions as urgent during the COVID-19 pandemic and were amenable to a telehealth appointment.
Keywords: Pelvic floor disorders, Patient perceptions, Urgency, Telehealth, COVID-19, Elective
Introduction
The quick spread of the COVID-19 pandemic deemed it a public health crisis that required the full attention of our health care systems immediately. Strategies to stop the spread of the virus, as well as to maximize resources for the care of COVID-19 patients, were implemented [1]. As a result, health care administrations around the USA chose to cancel all non-urgent medical activities as per the CDC’s recommendation [1]. In Florida specifically, elective procedures were canceled from 19 March 2020 to 30 April 2020 [2]. These cancellations ranged from clinic appointments to major operations, which impacted patients in many unpredictable ways.
Pelvic floor disorders (PFDs) include a variety of conditions that affect the tissues surrounding the pelvic organs, such as the bladder, rectum, uterus, and vagina in women [3, 4]. Some examples include uterine prolapse, urinary or fecal incontinence, a cystocele, or a rectocele [3, 4]. The prevalence of these disorders is hard to ascertain owing to different classification criteria and because a significant number of women with PFDs do not seek medical care, although numbers range from 2.9% to 23% [3–5]. These disorders can be very disabling for women. Still, they are largely considered non-urgent problems by medical professionals, and as a result, all medical appointments pertaining to them were canceled in early 2020 in Florida.
We know from previous studies that women rated certain symptoms of PFDs, such as incontinence, as severe [6]. Furthermore, studies have reported that women had a fear that health care providers may downplay the severity of their symptoms [7]. Given this background, we predicted that women with PFDs would be angered and significantly impacted by these cancellations. The aim of this quality improvement project was to help us to better understand our patients’ perceptions of the severity of their PFDs and to determine what factors influenced this perception, particularly in a patient population that is generally more vulnerable to the virus. We also aimed to better understand who might be amenable to telemedicine visits and what factors influenced this decision. We hypothesized that the majority of women would perceive their PFD as urgent and that various factors would influence this, including both the type of PFD, their other medical comorbidities, as well as their beliefs surrounding COVID-19. Furthermore, we hypothesized that the majority would not be amenable to telemedicine and instead would prefer to come in person given their demographics, specifically age.
Given the rarity of an event such as the COVID-19 pandemic, there are no studies exploring patient perceptions of the urgency of their PFDs during a global pandemic. This study was designed as a quality improvement project to assist us in better understanding the patient perspective, which may help us to provide better counsel to our patients in the future regarding PFDs.
Materials and methods
We conducted a cross-sectional quality improvement study. The population for this study comprised all consecutive patients, both new and established, who were being treated within a Female Pelvic Medicine and Reconstructive Surgery clinic in a university setting for a pelvic floor disorder during the COVID-19 pandemic. The inclusion criteria consisted of women at least 18 years of age diagnosed with a PFD and who spoke English or Spanish. Women under 18 years of age, without PFDs, or who did not speak English or Spanish were excluded. As this was a quality improvement study, the University of South Florida institutional review board deemed it exempt. From 19 March 2020 to 30 April 2020, a list of patients with cancelled appointments from our clinic was compiled and called by our co-investigators with the purpose of conducting a telephone survey. As part of this phone call triage, consent to participation was obtained from the patients, following which they were asked a series of scripted questions created by the research team to help us to understand their perception of the severity and urgency of their conditions. This information was used for research purposes only and did not alter medical management in any way. The co-investigators read questions from a telephone interview script shown in Fig. 1. Within the survey, non-urgency was defined as a rating of 3 or less. All responses provided during the telephone interview were recorded on a data collection form.
Fig. 1.
a–c These images represent the phone survey that was used to collect the data from patients
Data were summarized using proportions and descriptive statistics, including mean and standard deviation. Factors affecting perceived urgency and willingness to utilize telehealth appointments were tested using nonparametric Mann–Whitney U tests for continuous variables, Chi-squared tests, and Fisher’s exact tests for categorical variables. All tests used a significance level of p=0.05. Analysis was completed using SPSS software Version 27.
Results
Demographics
A total of 328 women met the inclusion criteria for participation and were called by the co-investigators. Of these, 97 women consented to completing the telephone survey, giving a 29.5% response rate. Further details about participation and response to the phone survey are shown in Fig. 2. Of these 97 patients, 5 women had surgeries cancelled whereas 92 had clinic appointments cancelled. Their median age was 62 (range 19–86) years. Participants predominantly consisted of white (74.2%), English-speaking (96.9%) patients who lived within a mean distance of 18 miles from their primary clinic site and who were established patients (75.3%). The most common primary complaint was pelvic organ prolapse (37.1%), followed by urinary incontinence (32.0%), pelvic pain (11.3%), and other urinary complications (11.3%), such as recurrent urinary tract infections, hematuria, or interstitial cystitis. The majority (79.4%) of the patients perceived their conditions to be non-urgent, and most of them (58.8%) would opt not to come into the clinic if given the opportunity. Further information from the survey are detailed in Table 1.
Fig. 2.
Flow diagram of response/participation in the telephone survey
Table 1.
Selected demographics of patients (N=97) with pelvic floor disorders
| Demographics | Data |
|---|---|
| Median age in years (range)* | 62 (19–86) |
| Race, n (%) | |
| White | 72 (74.2) |
| Black or African American | 7 (7) |
| Other | 9 (9.3) |
| Unknown or missing data | 9 (9.3) |
| Ethnicity, n (%) | |
| Not Hispanic, Latino, or Spanish | 74 (76.3) |
| Hispanic, Latino, or Spanish | 15 (15.5) |
| Unknown | 8 (8.2) |
| Preferred language, n (%) | |
| English | 94 (96.9) |
| Spanish | 1 (1.0) |
| Other | 2 (2.1) |
| Highest level of education, n (%) | |
| Some high school or below | 3 (3.1) |
| High school or equivalent | 23 (23.7) |
| Associates or vocational | 2 (2.1) |
| College | 30 (30.9) |
| Graduate school or above | 7 (7.2) |
| Unknown/missing data | 32 (33) |
| Median distance in miles from permanent address to the primary clinical site (range)* | 18 (1.1–1149) |
| Marital status, n (%) | |
| Single | 16 (16.5) |
| Married | 53 (54.6) |
| Divorced/separated | 16 (16.5) |
| Widowed | 5 (5.2) |
| Unknown or missing data | 7 (7.2) |
| Insurance coverage, n (%) | |
| Private/commercial | 33 (34.0) |
| Public (e.g., Medicare, Medicaid) | 58 (59.8) |
| Armed services | 6 (6.2) |
| Visit type, n (%) | |
| New patient | 24 (24.7) |
| Established patient | 73 (75.3) |
| Primary complaint, n (%) | |
| Pelvic organ prolapse | 36 (37.1) |
| Urinary incontinence | 31 (32.0) |
| Urinary complications | 11 (11.3) |
| Fecal incontinence | 3 (3.1) |
| Pelvic pain | 11 (11.3) |
| Other | 5 (5.2) |
| Perceived urgency of PFD, n (%) | |
| Non-urgent | 77 (79.4) |
| Urgent | 20 (20.6) |
| Presence of medical comorbidities, n (%) | |
| Hypertension | 40 (41.2) |
| Diabetes | 20 (20.6) |
| Pulmonary disease (COPD, OSA, asthma, etc.) | 23 (23.7) |
| Cardiovascular disease (CAD, MI, etc.) | 24 (24.7) |
| Cerebrovascular disease | 6 (6.2) |
| History of previous surgeries, n (%) | 87 (89.7) |
| History of previous urogynecologic surgeries, n (%) | 41 (42.3) |
| If given the opportunity to come into the clinic for an appointment, would you choose to come in?, n (%) | |
| Agree | 38 (39.2) |
| Disagree | 57 (58.8) |
| Don’t know | 2 (2.1) |
| If given the opportunity, would you choose to stay at home and have a telehealth visit with the doctor via the phone or computer?, n (%) | |
| Agree | 47 (48.5) |
| Disagree | 43 (44.3) |
| Don’t know | 7 (7.2) |
| Patient’s use of technology, n (%) | |
| Computer | 8 (8.2) |
| Tablet | 4 (4.1) |
| Smartphone | 27 (27.8) |
| Other/unspecified | 15 (15.5) |
| Missing data | 43 (44.3) |
| Perception of current health status, n (%) | |
| Good | 68 (70.1) |
| Fair | 23 (23.7) |
| Poor | 5 (5.2) |
| Familiarity with COVID-19, n (%) | |
| Not familiar | 3 (3.1) |
| Somewhat familiar | 8 (8.2) |
| Familiar | 21 (21.6) |
| Very familiar | 48 (49.5) |
| Expert | 17 (17.5) |
| Source of information, n (%) | |
| Social media | 14 (14.4) |
| News | 73 (75.3) |
| Friends/family | 16 (16.5) |
| Health care provider | 0 (0) |
| Patient is a health care provider | 0 (0) |
| Other | 0 (0) |
PFD pelvic floor disorder, COPD chronic obstructive pulmonary disease, OSA obstructive sleep apnea, CAD coronary artery disease, MI myocardial infarction
Factors influencing patient perceptions of urgency
In examining factors that influenced a patient’s perception of the urgency of their conditions, race (p=0.037), a history of diabetes (p=0.011), health status (p≤0.001), and willingness to attend an in-person appointment (p=0.010) were found to be statistically significant (Table 2). Patients who identified as nonwhite were more likely to perceive their conditions to be urgent (p=0.037). Among African American patients, 57.1% of patients perceived their conditions to be urgent, compared with 18.1% among whites. However, this was irrespective of the primary complaint. Patients with a history of diabetes were also more likely to perceive their conditions as urgent compared with those without diabetes (45.0% vs 15.3%, p=0.011). Personal perception of health was the most significant factor influencing whether a patient viewed their condition as being urgent (p<0.001). Only 10.3% of patients who believed that they were in “good” health perceived their conditions to be urgent, compared with 44.5% and 60% of those who saw themselves as having “fair” or “poor” health. Finally, patients who were willing to attend an in-person appointment were more likely to perceive their conditions as urgent (p=0.010). Willingness to participate in a telehealth appointment had no bearing on perceived urgency. Even those who perceived their conditions as being non-urgent were not more likely to attend a telehealth visit (p=0.320).
Table 2.
Factors associated with patient’s perception of urgency regarding their pelvic floor disorder
| Number of patients (n) | Patient perceives as non-urgent, n (%) | Patient perceives as urgent, n(%) | p value | |
|---|---|---|---|---|
| Primary complaint | 0.242 | |||
| Pelvic organ prolapse | 36 | 28 (77.8) | 8 (22.2) | |
| Urinary incontinence | 31 | 26 (83.9) | 5 (16.1) | |
| Urinary complications | 11 | 10 (90.9) | 1 (9.1) | |
| Pelvic pain | 11 | 6 (54.5) | 5 (45.5) | |
| Fecal incontinence | 3 | 2 (66.7) | 1 (33.3) | |
| Other | 5 | 5 (100) | 0 (0) | |
| Visit type | 0.773 | |||
| New patient | 24 | 20 (83.3) | 4 (16.6) | |
| Established patient | 73 | 57 (78.0) | 16 (22) | |
| Mean age (years)a | 47.49 | 54.80 | 0.301 | |
| Highest level of education | 0.574 | |||
| Some high school or below | 3 | 3 (100) | 0 (0) | |
| High school or equivalent | 23 | 19 (82.6) | 4 (17.4) | |
| Associates or vocational | 2 | 1 (50) | 1 (50) | |
| College | 30 | 25 (83.3) | 5 (16.7) | |
| Graduate school or above | 7 | 5 (71.4) | 2 (28.6) | |
| Race | 0.037 | |||
| White | 72 | 59 (81.9) | 13 (18.1) | |
| Black or African American | 7 | 3 (42.9) | 4 (57.1) | |
| Other | 9 | 6 (8.8) | 3 (15.1) | |
| Ethnicity | 0.313 | |||
| Hispanic, Latino, or Spanish | 15 | 10 (66.7) | 5 (33.3) | |
| Non-Hispanic, Latino, or Spanish | 74 | 59 (79.7) | 15 (20.3) | |
| Marital status | 0.494 | |||
| Single | 16 | 13 (81.3) | 3 (18.7) | |
| Married | 53 | 43 (81.1) | 10 (18.9) | |
| Divorced/separated | 16 | 11 (68.8) | 5 (31.2) | |
| Widowed | 5 | 3 (60) | 2 (40) | |
| Insurance | 0.469 | |||
| Private/commercial | 33 | 27 (81.8) | 6 (18.2) | |
| Public (Medicare/Medicaid) | 58 | 44 (75.9) | 14 (24.1) | |
| Armed services | 6 | 6 (100) | 0 (0) | |
| Presence of medical comorbidities | ||||
| Hypertension | 40 | 30 (75.0) | 10 (25.0) | 0.506 |
| Diabetes | 20 | 11 (55.0) | 9 (45) | 0.011 |
| Pulmonary disease | 23 | 18 (78.3) | 5 (11.7) | 0.974 |
| Cardiovascular disease | 24 | 19 (79.2) | 5 (20.8) | 0.900 |
| Cerebrovascular disease | 6 | 6 (100) | 0 (0) | 0.333 |
| Past surgeries | 1.00 | |||
| History of previous surgeries | 87 | 69 (79.3) | 18 (20.7) | |
| No history of previous surgeries | 5 | 4 (80.0) | 1 (20.0) | |
| Urogynecological surgeries | 0.427 | |||
| History of urogynecological surgeries | 41 | 31 (75.6) | 10 (24.4) | |
| No history of urogynecological surgeries | 51 | 42 (82.4) | 9 (17.6) | |
| Patient willingness to come into clinic | 0.010 | |||
| Would come in person | 38 | 25 (65.8) | 13 (34.2) | |
| Would not come in person | 57 | 50 (87.7) | 7 (82.3) | |
| Patient amenability for telehealth appointment | 0.32 | |||
| Would proceed with telehealth | 47 | 39 (83.0) | 8 (17.0) | |
| Would not proceed with telehealth | 43 | 32 (74.4) | 11 (25.6) | |
| Perception of current health status | < 0.001 | |||
| Good | 68 | 61 (89.7) | 7 (10.3) | |
| Fair | 23 | 13 (56.5) | 10 (44.5) | |
| Poor | 5 | 2 (40.0) | 3 (60.0) | |
| Familiarity with COVID | 0.770 | |||
| Not familiar or somewhat familiar | 11 | 8 (72.7) | 3 (27.3) | |
| Familiar | 21 | 16 (76.2) | 5 (23.8) | |
| Very familiar | 48 | 40 (83.3) | 8 (16.7) | |
| Expert | 17 | 13 (76.5) | 4 (23.5) | |
| Source of information | ||||
| Social media | 14 | 10 (71.4) | 4 (28.6) | 0.478 |
| News | 73 | 60 (82.2) | 13 (17.8) | 0.253 |
| Friends/family | 16 | 12 (75.0) | 4 (25.0) | 0.736 |
aContinuous variables, including age, are reported as mean ± standard deviation
Factors influencing telehealth participation
We also explored factors influencing a patient’s willingness to participate in a telehealth appointment. We found that ethnicity (but not race; p=0.019), marital status (p=0.036), and willingness to attend an in-person appointment (p=0.011) were statistically significant (Table 3). Only 23.1% of Hispanic, Latino or Spanish patients were willing to proceed with a telehealth appointment compared with 58.6% of non-Hispanic, Latino, or Spanish patients (p=0.019). Once again, this was irrespective of the primary complaint. Divorced/separated patients were significantly more likely to be amenable to a telehealth appointment–81.3% were amenable vs 57.1%, 44%, 25% in single, married, and widowed patients respectively (p=0.036). Finally, patients who were willing to come to an in-person visit during the pandemic were more likely to be amenable to a telehealth visit; 67.6% compared with 40.4% of those unwilling to come to an in-person visit (p=0.011).
Table 3.
Factors associated with patients’ choice to proceed with telehealth or to refuse
| Number of patients, n | Chooses to proceed with telehealth, n (%) | Refuses a telehealth visit, n (%) | p value | |
|---|---|---|---|---|
| Primary complaint | 0.096 | |||
| Pelvic organ prolapse | 33 | 14 (42.4) | 19 (57.6) | |
| Urinary incontinence | 31 | 20 (64.5) | 11 (35.5) | |
| Urinary complications | 9 | 7 (77.8) | 2 (22.2) | |
| Pelvic pain | 9 | 3 (33.3) | 6 (66.7) | |
| Fecal incontinence | 3 | 2 (66.7) | 1 (33.3) | |
| Other | 5 | 1 (20.0) | 4 (80.0) | |
| Visit type | 0.227 | |||
| New patient | 24 | 10 (41.7) | 14 (58.3) | |
| Established patient | 66 | 37 (56.1) | 29 (43.9) | |
| Perceived urgency of PFD | 0.320 | |||
| Non-urgent | 71 | 39 (54.9) | 32 (45.1) | |
| Urgent | 19 | 8 (42.1) | 11 (57.9) | |
| Mean age (years)a | 47.3 | 43.5 | 0.495 | |
| Highest level of education | 0.357 | |||
| Some high school or below | 3 | 3 (100) | 0 (0) | |
| High school or equivalent | 21 | 9 (42.9) | 12 (57.1) | |
| Associates or vocational | 2 | 1 (50.0) | 1 (50.0) | |
| College | 27 | 16 (59.3) | 11 (40.7) | |
| Graduate school or above | 7 | 5 (71.4) | 2 (28.6) | |
| Race | 0.388 | |||
| White | 66 | 38 (57.9) | 28 (42.1) | |
| Black or African American | 7 | 3 (42.9) | 4 (57.1) | |
| Other | 9 | 3 (33.3) | 6 (66.7) | |
| Ethnicity | 0.019 | |||
| Hispanic, Latino, or Spanish | 13 | 3 (23.1) | 10 (76.9) | |
| Non-Hispanic, Latino, or Spanish | 70 | 41 (58.6) | 29 (41.4) | |
| Marital status | 0.036 | |||
| Single | 14 | 8 (57.1) | 6 (42.9) | |
| Married | 50 | 22 (44.0) | 28 (56.0) | |
| Divorced/separated | 16 | 13 (81.3) | 3 (18.7) | |
| Widowed | 4 | 1 (25.0) | 3 (75.0) | |
| Insurance | 0.408 | |||
| Private/commercial | 30 | 14 (46.7) | 16 (53.3) | |
| Public (Medicare/Medicaid) | 54 | 31 (57.4) | 23 (42.6) | |
| Armed services | 6 | 2 (33.3) | 4 (66.7) | |
| Presence of medical comorbidities | ||||
| Hypertension | 39 | 25 (64.1) | 14 (35.9) | 0.133 |
| Diabetes | 20 | 11 (55.0) | 9 (45.9) | 0.976 |
| Pulmonary disease | 20 | 10 (50.0) | 10 (50.0) | 0.624 |
| Cardiovascular disease | 23 | 12 (52.2) | 11 (47.8) | 0.725 |
| Cerebrovascular disease | 6 | 1 (20.0) | 5 (80.0) | 0.085 |
| Past surgeries | 1.00 | |||
| History of previous surgeries | 80 | 42 (52.5) | 38 (47.5) | |
| No history of previous surgeries | 5 | 3 (60.0) | 2 (40.0) | |
| Urogynecological surgeries | 0.290 | |||
| History of urogynecological surgeries | 37 | 22 (59.5) | 15 (40.5) | |
| No history of urogynecological surgeries | 48 | 23 (47.9) | 25 (52.1) | |
| Patient willingness to come into clinic | 0.011 | |||
| Would come in person | 37 | 25 (67.6) | 12 (42.4) | |
| Would not come in person | 52 | 21 (40.4) | 31 (59.6) | |
| Perception of current health status | 0.209 | |||
| Good | 62 | 29 (46.8) | 33 (53.2) | |
| Fair | 22 | 15 (68.2) | 7 (31.8) | |
| Poor | 5 | 3 (60.0) | 2 (40.0) | |
| Familiarity with COVID-19 | 0.612 | |||
| Not familiar | 2 | 0 (0) | 2 (100) | |
| Somewhat familiar | 6 | 2 (33.3) | 4 (66.7) | |
| Familiar | 20 | 11 (55.0) | 9 (45.0) | |
| Very familiar | 47 | 26 (55.3) | 21 (44.7) | |
| Expert | 15 | 8 (53.3) | 7 (46.7) | |
| Source of information | ||||
| Social media | 13 | 7 (53.8) | 6 (46.2) | 0.899 |
| News | 68 | 39 (57.4) | 29 (42.6) | 0.087 |
| Friends/family | 15 | 5 (33.3) | 10 (66.7) | 0.109 |
n can differ for variables owing to missing data or single patients providing multiple responses
aContinuous variables, including age are reported as mean ± standard deviation
Discussion
Our study demonstrated that during the COVID-19 pandemic, the majority of women in our study did not view their conditions as being urgent, irrespective of the PFD. This was somewhat surprising to us as we know from previous studies that PFDs significantly impact patients’ quality of life and are associated with feelings of shame and embarrassment [5]. One study demonstrated that women with PFDs rated adverse outcomes (from the disorder itself or as an adverse outcome of the corrective surgery) such as incontinence, constipation, sexual dysfunction, and nocturia as very severe outcomes and rated them as similar in severity to intensive care unit admissions [7]. So, although the results supported the null hypothesis, the authors surmise that this may be because this was a very unique, once-in-a-lifetime scenario that may have created great fear in many women.
There are only a few studies that have looked at patient perspectives during this pandemic, although to our knowledge, none has looked at perceived urgency among women with PFDs [8–10]. One study examined another group of women whose elective procedures were cancelled—in this case, fertility patients who could not receive care because of the pandemic. And, contrary to our results, the majority would have preferred to proceed with receiving care [8]. These differing results are not too surprising to the authors in that our cohort of patients with urogynecological disorders is quite different from fertility patients, both in age and in associated comorbidities. Furthermore, a cohort of patients who often pay for their services and that are often very time dependent may be more inclined to continue those services.
Although the majority of women in our study did not perceive their PFDs as being urgent, certain factors did influence the likelihood of women identifying their PFD as urgent. One of these included negative perceptions of the patients’ own health. From these results it is difficult to surmise how much their perception of poor health status influenced their feelings about their PFD, or whether their PFD drove the perception of their poor health status. Previous studies have shown that a poor understanding of these conditions as well as the perceived severity of symptoms led women to believe that their overall health status was poor [5, 11, 12].
We also found that African Americans, and patients with diabetes, were more likely to perceive their conditions as being urgent. This finding supports other studies that show that minority populations are likely to perceive their conditions as being urgent [7, 13]. Possible causes of these include decreased health literacy, cultural barriers, and prioritizing family needs over health [6, 7]. Similarly, given that diabetes mellitus is a risk factor for PFDs such as urinary incontinence, it may be that these women had a more severe state of incontinence or that patients with diabetes may be hyper concerned about their health owing to all the feared complications of their disease, which would lead them to view their conditions as being more urgent [14, 15]. Finally, patients who wanted to come into the office for an in-person appointment were significantly more likely to view their condition as urgent, and this makes intuitive sense, as those patients felt that their conditions were urgent enough that they had to be seen.
Amenability to a telehealth visit was another important outcome for our study as we aimed to figure out who might be amenable to this technology moving forward. We hypothesized that the majority of women would not be amenable to a telehealth appointment given that our urogynecological population, which typically consists of older women, might not be able to use this technology. However, the data for this were much less uniform (43 women refused a telehealth visit and 47 were amenable). Furthermore, surprisingly, age was not predictive in our study. Factors that were associated with amenability to telehealth included ethnicity, marital status, and willingness to attend an in-person visit. Hispanic, Latino, and Spanish-speaking women were least likely to attend a telehealth visit. This could be caused by reduced accessibility by minority populations, as well as a perceived language barrier, rendering telehealth impractical from their perspective. It is unclear why divorced/separated women were more amenable to a telehealth appointment, but perhaps because PFDs are often sensitive and embarrassing topics for women, concern for lack of privacy with a partner or spouse in the home was a deterrent. Finally, patients who were willing to come in for an in-person appointment were more likely to be amenable to a telehealth appointment. This was not a surprising finding as it points to the fact that these women would like to be seen regardless of the method.
We acknowledge that this study has limitations. First, the small sample size decreased our ability to find differences where they may exist, and a largely non-Hispanic white population limits the generalizability of our findings. Furthermore, the data collection method for this study was a telephone survey with nonvalidated questionnaires. Also, patients struggled to answer certain questions or refused to answer others during the survey, which resulted in some missed information. Despite these limitations, we believe that our study provides valuable insight into patient perspectives during this unique time. Further quality improvement projects exploring issues such as these can help us to further increase our understanding of patient perceptions.
Predicting how health care providers and patients will react to a once-in-a-lifetime event such as a pandemic is challenging. During the COVID-19 pandemic, the majority of women in our study did not view their conditions as being urgent, although some factors such as race and overall health status did alter this likelihood. These data can be used by clinicians to influence their practice regarding communication with patients. It is clear that it is important to discuss topics such as how patients feel about the urgency of their pathological condition, fear regarding COVID-19, or the usefulness of telehealth. Results such as these can help us to acknowledge our bias with regard to patients’ perceptions and provide a better understanding of the patient perspective, which will ultimately improve the health care we provide.
Acknowledgements
We would like to acknowledge Ryan Hidalgo, MD, who assisted in the creation of the tables and in providing mentorship to the medical students in the completion of this project.
Authors’ contributions
O. Kattih: data collection and manuscript writing/editing; V. Battistoni: data collection; E. Coughlin: data analysis; R. Mhaskar: data analysis and manuscript writing/editing; L. Menezes: manuscript writing/editing; K. Greene: protocol/project development and manuscript writing/editing.
Declarations
Financial disclaimer/conflicts of interest
None.
Footnotes
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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