Shared decision-making among patients undergoing surgery for pelvic floor dysfunction: a cross-sectional study

Abstract

Background

Shared decision-making (SDM) is a key component of patient-centered care for individuals with pelvic floor dysfunction (PFD); however, evidence on patient satisfaction with decision-making and its associated factors in PFD surgery remains limited.

Methods

A cross-sectional study was conducted among patients scheduled for PFD surgery. Structured questionnaires and medical record data were used to evaluate decision-making satisfaction and associated factors.

Results

A total of 123 participants were included, with an average age of 57.24 ± 13.12 years. Regarding decision-making roles, 85.4% (105/123) of patients reported actual involvement in SDM. The mean SDM quality score was 89.02 ± 8.57, and the mean overall satisfaction score was 86.32 ± 12.77. Scores for the four dimensions of overall satisfaction were as follows: information (83.08 ± 16.76); communication and negotiation (82.88 ± 17.16); decision-making (87.80 ± 12.77); satisfaction and confidence (90.77 ± 11.98). Correlation analysis showed that overall satisfaction was positively correlated with all four dimensions of the satisfaction scale, with the strongest correlation observed for the communication and negotiation (r = 0.91), followed by information (r = 0.88), satisfaction and confidence (r = 0.86), and decision-making (r = 0.81). Univariate analysis indicated that surgical procedures, educational attainment, economic status, and residential location were correlation with patient overall satisfaction. Multivariate analysis revealed that SDM quality was the strongest predictor of satisfaction (t = 17.92, β = 0.84, P < 0.001), and independently explained 65.4% of the variance in patient overall satisfaction (F = 50.92, P < 0.001).

Conclusions

Most patients reported high actual involvement in SDM and high overall satisfaction. SDM quality was the strongest independent predictor of patient overall satisfaction, highlighting the need for targeted interventions to improve SDM quality and optimize information delivery and communication.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-026-04430-1.

Background

Pelvic floor dysfunction (PFD), encompassing conditions such as pelvic organ prolapse (POP), urinary incontinence, and fecal incontinence, affects millions of women worldwide and poses a significant public health concern [1]. Epidemiological data indicate that PFD affects approximately 45.0% of women in China, with prevalence increasing with age; urinary incontinence and POP are estimated to affect 30.9% and 20.0% of women, respectively [2–4]. Although PFD is not life-threatening, it can profoundly impair quality of life through symptoms such as pelvic pressure, pain, urinary and bowel disturbances, sexual dysfunction, and psychological sequelae, including depression, anxiety, and social isolation [5–8]. Current therapeutic strategies, including pharmacological treatment, physical therapy, and surgical intervention, offer varying risk–benefit profiles, yet suboptimal outcomes and recurrence rates remain common [9–12]. These challenges underscore the need for greater patient involvement in treatment decisions.

Shared decision-making (SDM), a process in which clinicians and patients collaboratively weigh evidence and preferences to reach treatment decisions, has been shown to enhance patient engagement, improve understanding of treatment options, increase treatment satisfaction, and clinical outcomes [13, 14]. For women with PFD, the complexity of surgical options and the need to balance risks and benefits make SDM particularly relevant. However, research on SDM in PFD surgical decision-making and its association with patient satisfaction remains scarce. Accordingly, this cross-sectional study evaluated overall satisfaction with the decision-making process as the primary outcome in women undergoing PFD surgery and examined its associations with sociodemographic and clinical characteristics, actual and expected decision-making roles, and SDM quality.

Methods

Study design and participants

This cross-sectional study was conducted at Yan'an Hospital affiliated to Kunming Medical University, from October 1, 2024, to August 31, 2025. Patients scheduled for PFD surgery were consecutively recruited. Inclusion criteria: (1) diagnosis of PFD [15] and scheduling for surgical treatment; (2) voluntary participation in this study; (3) provision of informed consent. Exclusion criteria: (1) severe speech or communication impairments; (2) inability to complete the questionnaires independently due to mental illness, cognitive impairment, or other related conditions; (3) withdrew consent during the study; (4) more than 20.0% missing data in the questionnaire. The investigators were trained in questionnaire administration and did not participate in the medical procedures. This study was approved by the Medical Ethics Research Committee of Yan'an Hospital Affiliated to Kunming Medical University (approval NO. YXLL-SOP-016–01). All participants provided written informed consent prior to enrollment.

Data collection

Sociodemographic and clinical characteristics, including age, marital status, educational attainment, residence, monthly household income, and type of surgical procedures, were obtained through medical records.

Structured questionnaires

Questionnaire 1 was the Control Preference Scale (CPS) (Table S1), which was used to assess patients' preferred roles in decision-making [16]. The Chinese version of the scale was translated by Xu et al. in 2010, with a test–retest reliability coefficient of 0.856 [17]. Questionnaire 2 was the 9-item Shared Decision Making Questionnaire (SDM-Q-9) (Table S2), which was used to measure patients' perceptions of the SDM process [18]. The questionnaire was translated into Chinese in 2019 [19]. Subsequent research measured Cronbach's α of 0.852 and Kaiser-Meyer-Olkin (KMO) coefficient of 0.852 [20]. In the present study, Cronbach's α was 0.793 and the KMO coefficient was 0.805. Multiplication of the raw score by 20/9 provides a score transformed to range from 0 to 100, where 0 indicates the lowest possible level of SDM and 100 indicates the highest extent of SDM [18]. Questionnaire 3 was the Patient Satisfaction with Participation in Medical Decision-Making Scale, which was used to evaluate patient-reported overall satisfaction with the decision-making process across four dimensions: information, communication and negotiation, decision-making, and satisfaction and confidence. Previous research by Xu reported good content validity and reliability, with a Cronbach's α of 0.899 and a test–retest reliability coefficient of 0.906 [17]. In the present study, Cronbach's α was 0.913 and the KMO coefficient was 0.867. The information dimension includes items 1–4; the communication and negotiation dimension includes items 5–8; the decision-making dimension includes items 9–11; and the satisfaction and confidence dimension includes items 12–16 (Table S3). The survey was administered after the preoperative consultation and prior to surgery. For comparability, item scores were converted to a 0–100 scale by subtracting 1 from the raw score and multiplying the result by 25 [17]. The score for each dimension was calculated as the mean of the converted item scores within that dimension. The overall satisfaction score was calculated as the mean of the scores across all four dimensions, with higher scores indicating greater satisfaction.

Statistical analysis

Data were analyzed using SPSS version 26.0 (IBM SPSS Statistics), and sample size adequacy was evaluated using PASS software. Continuous variables with a normal distribution were expressed as mean ± standard deviation (SD), and categorical variables were summarized as frequencies and percentages. Group comparisons were performed using independent-samples t-tests or one-way analysis of variance (ANOVA), with Post hoc multiple comparisons conducted using the least significant difference (LSD) method or Tamhane's T2 test depending on the homogeneity of variances. Pearson correlation analysis was used to evaluate the associations between overall satisfaction and its four dimensions in the Patient Satisfaction with Participation in Medical Decision-Making Scale. Univariate analyses were first performed to screen for factors associated with patient overall satisfaction, followed by multivariable linear regression to identify independent predictors. A significance level of P < 0.05 was considered statistically significant.

Results

Participant characteristics

A total of 136 participants were initially recruited for this study. Of these, 9 participants were excluded because they refused to continue participating, and 4 were excluded due to more than 20.0% missing questionnaire data. Ultimately, 123 participants were included in the final analysis, yielding a valid response rate of 90.4% (Fig. 1).

Fig. 1.

Flowchart of patient enrollment

A post hoc power analysis was performed using PASS software based on the observed difference in the primary outcome measure (overall satisfaction), between surgical procedure groups (POP surgery: n = 87, 84.46 ± 13.12; SUI surgery: n = 34, 91.50 ± 10.47). The results showed that, at a significance level of α = 0.05, the achieved statistical power was 0.86 (> 0.80). This finding suggests that the current sample size was sufficient to support the primary conclusions regarding between-group differences.

The mean age was 57.24 ± 13.12 years, with most patients aged 46–55 years (33.3%, 41/123). Most participants were married (85.4%, 105/123) and lived in rural areas (52.8%, 65/123). Monthly household income was predominantly low to middle, with 40.7% (50/123) earning less than CNY 1,999 and 45.5% (56/123) between CNY 2,000–4,999. Regarding education, nearly half (48.0%, 59/123) had completed primary school or below, whereas only 13.0% (16/123) had attained college or higher education. In terms of surgical procedures, 70.7% (87/123) of participants underwent surgery for POP, 27.7% (34/123) for stress urinary incontinence (SUI), and 1.6% (2/123) underwent surgery for IV degree old perineal laceration1 [21]. Regarding decision-making roles, 85.4% (105/123) of participants reported actual involvement in SDM, whereas 8.1% (10/123) and 6.5% (8/123) reported passive and proactive involvement, respectively. Expectations for participation in SDM were slightly lower: 62.6% (77/123) preferred SDM, while 18.7% (23/123) favored passive involvement and another 18.7% (23/123) preferred a proactive role (Table 1).

Table 1.

Patient characteristics (n = 123)

Characteristics	No./total No.(%)
Age, Mean (SD) (years old)	57.24 ± 13.12
< = 45	23/123(18.7)
46–55	41/123(33.3)
56–65	27/123(22.0)
66–75	23/123(18.7)
> 76	9/123(7.3)
Marriage
Married	105/123(85.4)
Divorced	4/123(3.2)
Widowed	14/123(11.4)
Residential location
Urban areas	58/123(47.2)
Rural areas	65/123(52.8)
Monthly household income (CNY)
< 1999	50/123(40.7)
2000–4999	56/123(45.5)
5000–9999	17/123(13.8)
Educational attainment
Primary school or below	59/123(48.0)
Junior high school	30/123(24.4)
Senior high school	18/123(14.6)
College or above	16/123(13.0)
Surgical procedures
POP surgery	87/123(70.7)
SUI surgery	34/123(27.7)
Perineal laceration surgery	2/123(1.6)
Participation in decision-making roles
Shared decision-making	105/123(85.4)
Passive decision-making	10/123(8.1)
Proactive decision-making	8/123(6.5)
Expected decision-making role
Shared decision-making	77/123(62.6)
Passive decision-making	23/123(18.7)
Proactive decision-making	23/123(18.7)
Satisfactory(> = 75 points)
Not satisfied	20/123(16.1)
Satisfied	103/123(83.0)

CNY Chinese Yuan, POP Pelvic organ prolapse, SUI Stress urinary incontinence

SDM quality and patient overall satisfaction

According to this study, the mean SDM quality was 89.02 ± 8.57. Among these, item 5 received the lowest score (4.11 ± 0.88), while item 9 received the highest score (4.71 ± 0.49). The mean overall satisfaction score was 86.32 ± 12.77, and 83.7% (103/123) of participants had an overall satisfaction score greater than 75. The mean scores for the four dimensions were as follows: information (83.08 ± 16.76), communication and negotiation (82.88 ± 17.16), decision-making (87.80 ± 12.77), satisfaction and confidence (90.77 ± 11.98). Notably, the lowest scores were observed for Item 4 in the information dimension (72.56 ± 27.80) and Item 8 in communication and negotiation (75.40 ± 26.00). Conversely, Item 10 in decision-making dimension achieved the highest score of 93.70 ± 11.36 (Table 2).

Table 2.

The Score of the share decision-making quality and the patient overall satisfaction with participation in medical decision-making (n = 123)

	No	Mean	SD
SDM-Q-9
Item 1	123	4.57	0.57
Item 2	123	4.29	0.85
Item 3	123	4.39	0.73
Item 4	123	4.53	0.64
Item 5	123	4.11	0.88
Item 6	123	4.24	0.77
Item 7	123	4.54	0.70
Item 8	123	4.67	0.54
Item 9	123	4.71	0.49
Overall score	123	89.02	8.57
Patient Satisfaction with SDM
Information	123	83.08	16.76
Item 1	123	89.63	18.37
Item 2	123	82.93	22.25
Item 3	123	87.20	18.77
Item 4	123	72.56	27.80
Communication and negotiation	123	82.88	17.16
Item 5	123	89.84	17.49
Item 6	123	77.64	25.97
Item 7	123	88.62	19.27
Item 8	123	75.41	26.00
Decision-making	123	87.80	12.77
Item 9	123	78.86	22.87
Item 10	123	93.70	11.36
Item 11	123	90.85	16.72
Satisfaction and confidence	123	90.77	11.98
Item 12	123	93.09	12.52
Item 13	123	91.26	13.57
Item 14	123	92.48	13.56
Item 15	123	84.55	19.08
Item 16	123	92.48	14.65
Overall satisfaction	123	86.32	12.77

SDM-Q-9 The 9-item Shared Decision Making Questionnaire

Analysis of overall satisfaction and its four dimensions

Correlation analysis demonstrated positive associations between overall satisfaction and the four dimensions of the patient satisfaction scale. The strongest correlation was observed for the communication and negotiation dimension (r = 0.91), followed by information (r = 0.88), satisfaction and confidence (r = 0.86), and decision-making (r = 0.81) (Fig. 2, Table S4).

Fig. 2.

Heatmap correlation analysis of overall satisfaction and its four dimensions

A multivariable linear regression analysis was conducted to examine whether the information, communication and negotiation, and decision-making dimensions of patients' participation in medical decision-making were associated with the satisfaction and confidence dimension. The results indicated that both the information dimension (t = 2.64, β = 0.24, P = 0.009) and decision-making dimension (t = 0.52, β = 0.25, P < 0.001) were independently correlated with satisfaction and confidence dimension. Together, the information and decision-making dimensions accounted for 61.2% of the variance in the satisfaction and confidence outcomes (Table S5).

Factors associated with patient overall satisfaction: univariate and multivariate analyses

Univariate analysis revealed that surgical procedures, economic status, educational attainment, and residential location were significantly associated with patient overall satisfaction (Table 3). No significantly associated were observed for age, marital status, roles in decision-making, or expectations regarding decision-making (Table S6-S9).

Table 3.

Analysis of differences in surgical procedures, economic status, educational attainment and residential location for overall satisfaction and its four dimensions (n = 123)

	No	Mean	SD	F	P
Surgical procedures
Overall satisfaction
POP surgery	87	84.46	13.12	−3.98	< 0.001
SUI surgery	34	91.5	10.47
Information
POP surgery	87	80.17	17.73	−2.49	0.014
SUI surgery	34	90.99	11.33
Communication and negotiation
POP surgery	87	80.82	17.26	−2.54	0.013
SUI surgery	34	89.15	14.62
Decision-making
POP surgery	87	86.49	12.85	−1.56	0.121
SUI surgery	34	92.16	10.25
Satisfaction and confidence
POP surgery	87	89.6	12.63	−2.80	0.006
SUI surgery	34	93.38	10.05
Economic status
Overall satisfaction
< 1999	50	81.63	12.93	6.20	0.003
2000–4999	56	89.37	12.40
5000–9999	17	90.07	9.34
Information
< 1999	50	76.38	17.51	7.45	0.001
2000–4999	56	87.61	15.83
5000–9999	17	87.87	10.24
Communication and negotiation
< 1999	50	77.75	17.09	3.96	0.022
2000–4999	56	86.16	17.55
5000–9999	17	87.13	12.40
Decision-making
< 1999	50	85.00	12.82	2.13	0.123
2000–4999	56	89.43	12.96
5000–9999	17	90.69	10.98
Satisfaction and confidence
< 1999	50	86.90	12.41	4.68	0.011
2000–4999	56	93.30	11.45
5000–9999	17	93.82	9.61
Educational attainment
Overall satisfaction
Primary school or below	59	84.11	14.10	1.51	0.217
Junior high school	30	86.93	9.69
Senior high school	18	88.37	12.62
College or above	16	91.02	12.12
Information
Primary school or below	59	79.34	18.18	2.82	0.042
Junior high school	30	84.38	12.15
Senior high school	18	85.07	19.78
College or above	16	92.19	11.30
Communication and negotiation
Primary school or below	59	81.67	17.40	0.91	0.437
Junior high school	30	81.88	14.99
Senior high school	18	82.64	22.13
College or above	16	89.45	13.45
Decision-making
Primary school or below	59	86.44	13.30	0.57	0.636
Junior high school	30	88.33	11.91
Senior high school	18	90.74	11.39
College or above	16	88.54	14.23
Satisfaction and confidence
Primary school or below	59	88.47	13.59	1.52	0.214
Junior high school	30	92.17	10.06
Senior high school	18	94.17	7.91
College or above	16	92.81	11.97
Residential location
Overall satisfaction
Urban areas	58	88.77	11.42	2.05	0.042
Rural areas	65	84.13	13.58
Information
Urban areas	58	86.31	14.27	2.05	0.043
Rural areas	65	80.19	18.34
Communication and negotiation
Urban areas	58	86.31	14.07	2.17	0.032
Rural areas	65	79.81	19.1
Decision-making
Urban areas	58	88.22	14.05	0.34	0.736
Rural areas	65	87.44	11.61
Satisfaction and confidence
Urban areas	58	93.02	10.64	2.01	0.047
Rural areas	65	88.77	12.81

POP Pelvic organ prolapse, SUI Stress urinary incontinence

As for surgical procedures (Perineal laceration surgery was exclude due to its small sample size, n = 2), patients undergoing SUI surgery reported significantly higher overall satisfaction than those undergoing POP surgery (91.50 ± 10.47 vs. 84.46 ± 13.12, P < 0.05), with consistently higher scores across the information, communication and negotiation, and satisfaction and confidence dimensions (P < 0.05), but no significant difference in the decision-making dimension (P > 0.05) (Fig. 3a, Table 3).

Fig. 3.

Analysis of differences overall satisfaction and its four dimensions. a Distribution of satisfaction differences across different surgical procedures. b Distribution of satisfaction differences according to economic status. c Distribution of satisfaction differences by educational attainment. d Distribution of satisfaction differences by residential location. (*, **, *** indicate < 0.05, 0.01, 0.001)

As for economic status, patients with monthly household income of CNY 2,000–4,999 and CNY 5,000–9,999 reported higher overall satisfaction than those earning < CNY 1,999 (P < 0.05), with no difference between the CNY 2,000–4,999 and CNY 5,000–9,999 groups. Similar trends were observed across the information, communication and negotiation, and satisfaction and confidence dimensions (P < 0.05). While, in the decision-making dimension, no significant differences were observed among the three income groups (P > 0.05) (Fig. 3b, Table 3).

For educational attainment, no significant differences were found in overall satisfaction. However, in the information dimension, patients with a college education or above scored significantly higher than those with a primary school education (92.19 ± 11.30 vs. 79.34 ± 18.18, P < 0.05) (Fig. 3c, Table 3).

Regarding residential location, patients residing in urban areas reported higher overall satisfaction compared with those in rural areas (88.77 ± 11.42 vs. 84.13 ± 13.58, P < 0.05). Urban residents also scored higher in the information, communication and negotiation, and satisfaction and confidence dimensions (P < 0.05), with no significant difference observed in the decision-making dimension (P > 0.05) (Fig. 3d, Table 3).

To further explore the factors associated with patient overall satisfaction with SDM, surgical procedures, economic status, educational attainment, and residence were included in the multivariable linear regression model (Model 1). The results demonstrated that the model was statistically significant (F = 3.22, P < 0.001), with an adjusted R² of 0.115. Both surgical procedures (t = 2.86, β = 0.25, P = 0.005) and economic status (t = −2.39, β = −0.26, P = 0.019) were associated with patient overall satisfaction, with patients undergoing POP surgery reporting lower satisfaction than those undergoing SUI surgery, and patients with a monthly household income of less than CNY 1,999 reporting lower satisfaction than those in the CNY 2,000–4,999 income group. Collinearity diagnostics revealed that all variables had VIF < 2, indicating no severe multicollinearity (Table S10).

Based on Model 1, SDM quality was additionally included in the regression to construct Model 2. The full model was statistically significant (F = 50.92, P < 0.001), with the adjusted R² increasing to 0.769 and a change in R² (ΔR² = 0.654), indicating that SDM decision quality independently explained 65.4% of the variance in patient overall satisfaction and emerged as the strongest predictor of satisfaction (t = 17.92, β = 0.84, P < 0.001). In Model 2, the associations of surgical procedures and economic status with overall satisfaction were attenuated and were no longer statistically significant. This finding suggests that differences in overall satisfaction across surgical procedures and income groups may be related to variation in SDM quality. In addition, after adjustment for SDM quality, educational attainment was positively associated with overall satisfaction (t = 2.13, β = 0.11, P = 0.035); however, the standardized regression coefficient was small (|β|< 0.2), indicating limited practical significance. Collinearity diagnostics for Model 2 confirmed that all variables had VIF < 2, indicating no severe multicollinearity (Table S11).

Discussion

Our study found that 85.4% of patients reported actual participation in SDM, whereas only 62.6% had expected such involvement. While actual participation rate aligns with Ming Jian et al.'s findings of 85.8%−91.5% among 950 patients, our expected participation rate was notably lower than their reported range of 83.4%−94.3% [22]. likely reflecting differences in patient demographics and SDM implementation practices. Furthermore, we observed that fewer patients expected to participate in SDM than actually did so, while the proportions of patients who expected either passive or proactive decision-making were higher than those who actually engaged in these respective roles. This result may be attributed to patients' limited awareness of SDM, insufficient opportunities for discussion, and a tendency to defer to physician authority [23]. Furthermore, some physicians may not have effectively encouraged patient involvement, with some mistakenly equating SDM with informed consent [24, 25]. To address these issues, healthcare professionals should engage in SDM-related training, enhance patient education to raise awareness, and allow adequate time for patients to deliberate on their treatment options.

Our study demonstrated higher SDM quality scores in PFD management compared with other clinical settings, such as urological surgery [26]. However, item-level analysis of the SDM-Q-9 revealed important variation across dimensions of the decision-making process: Item 5 ("My doctor helped me understand all the information") received a comparatively low score, whereas Item 9 ("My doctor and I reached an agreement on how to proceed") received relatively high scores, suggesting that agreement on treatment may have been reached even when patients' understanding of the information remained incomplete, possibly reflecting greater reliance on physician trust than on informed deliberation. Dimension-level analysis of overall satisfaction further corroborated this finding: with the highest scores observed for the decision-making dimension and satisfaction and confidence dimension, and comparatively lower scores found for the information dimension and communication and negotiation dimension; notably, "The information provided by the doctor is easy to understand" and "The doctor asked me if I understood the information he had provided" received the lowest item-level scores, whereas "Regarding the treatment for my condition, the doctor provided me with sufficient advice" received the highest. These findings consistently suggest that although physicians tend to provide information comprehensively, they demonstrate notable deficiencies in confirming adequate patient comprehension—a gap likely amplified by the study population's characteristics, which was predominantly composed of older individuals with low income and limited educational attainment, factors known to exacerbate information asymmetry and increase barriers to SDM, including communication difficulties and limited willingness to participate [23, 27–31]. Consistent with this, multivariable regression analysis identified the information and decision-making dimensions were independently correlated with satisfaction and confidence dimension, collectively explaining 61.2% of the variance, underscoring the central role of effective information delivery in shaping patients' overall experience and highlighting the need for targeted improvements in information comprehension, particularly among rural, low-income, and low-literacy patient populations.

The present study confirms that SDM quality is the strongest independent predictor of patient overall satisfaction, accounting for 65.4% of its variance, consistent with evidence that SDM interventions significantly improve satisfaction while reducing decisional regret and conflict [32, 33]. Patient Decision Aids (PtDAs) represent the most direct and efficacious intervention and have been widely applied across multiple clinical fields [29], with several tools currently available in urology and female pelvic medicine and reconstructive surgery [23]. Additionally, standardized SDM training programs, such as those provided by the Ottawa website, have demonstrated effectiveness in promoting physician engagement in shared decision-making [34].

This study found that surgical procedure type and patients' economic status were associated with overall satisfaction when SDM quality was not included in the model. However, following the introduction of SDM quality, the associations of both variables were attenuated, suggesting that differences in SDM quality across procedure types and income levels may be related to the observed disparities in patient satisfaction. Consistent with prior research [35, 36], low-income patients reported higher decisional conflict and lower decision satisfaction, possibly reflecting that financial constraints are associated with limited options and consequently reduced participation in decision-making. Furthermore, patients undergoing SUI surgery reported higher satisfaction than those undergoing POP surgery. To our knowledge, no comparable studies have been reported. This disparity may be partly explained by the notably older age profile of POP patients relative to SUI patients [37–39], as well as the greater clinical complexity of POP. Specifically, POP encompasses a wider range of symptoms, more diverse surgical options, and a broader spectrum of potential complications (Table S12) [40, 41]. Collectively, these factors may give rise to heightened information complexity and increased patient anxiety, which in turn could undermine the quality of SDM and ultimately diminish overall satisfaction with the decision-making process among POP patients. These findings suggest that improving SDM quality among POP patients and low-income populations may be an indirect factor associated with patient overall satisfaction.

Several limitations should be acknowledged. First, the relatively small sample size from a single center may limit the generalizability of the findings; Second, satisfaction was assessed exclusively in terms of the decision-making process, without incorporating postoperative outcomes; future studies will include decision outcome measures for a more comprehensive evaluation. Third, the cross-sectional design limits causal inference, and the retrospective self-report nature of the study may have introduced differences in interpretation or recall, thereby increasing the risk of measurement bias.

Conclusion

In PFD surgery, SDM has achieved high levels of implementation effectiveness and patient overall satisfaction. However, important gaps remain in information comprehension and communication, particularly among older, low-income, and less-educated patients. SDM quality emerged as the strongest independent predictor of patient overall satisfaction. These findings suggest that efforts to improve SDM in pelvic floor dysfunction care should prioritize clearer information delivery, confirmation of patient understanding, and more active patient involvement, especially for patients undergoing POP surgery and those with limited economic resources.

Abbreviations

ANOVA

Analysis of variance

CPS

Control Preference Scale

KMO

Kaiser-Meyer-Olkin

LSD

Least significant difference

PFD

Pelvic floor dysfunction

POP

Pelvic organ prolapse

SDM

Shared decision-making

SDM-Q-9

9-item Shared Decision Making Questionnaire

SD

Standard deviation

SUI

Stress urinary incontinence

Authors’ contributions

DY participated in data collection, performed statistical analyses, interpreted the findings, prepared figures, charts, and graphs to visualize the data and results, and drafted the manuscript. XL gathered and structured the data for analysis, revised the manuscript, performed a comprehensive literature review, collected, cleaned, and revised the manuscript. MC supervised its implementation, structured the data for analysis, interpreted the findings, cleaned, and revised the manuscript. LY supervised its implementation and structured the data for analysis. WJ participated in data collection, performed statistical analyses and structured the data for analysis. XH conceived and designed the study, supervised its implementation, interpreted the results, and critically revised the manuscript. Additionally, secured funding and oversaw overall project management. All authors contributed to the writing of the manuscript.

Funding

This work was supported by Yunnan Province Medical Leading Talent Project (L-2019005), Basic Research Program from Department of Science and Technology of Yunnan Province Joint with Kunming Medical University (202401AY070001-374).

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Medical Ethics Research Committee of Yan'an Hospital Affiliated to Kunming Medical University with approval number YXLL-SOP-016–01. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality, and provided written consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.