Expectations Versus Experience: A Qualitative Study on Patient Perspectives in Urogynecologic Surgery

INTRODUCTION: While surgeons and members of the medical care team become well-versed with the surgical journey through familiarity and repetition, the process is unfamiliar to most patients, and they may experience apprehension, fear, and distress. Patients and their surgeons must often bridge a broad gap in anatomic knowledge, medical literacy, and expectations. Some studies suggest that this information gap leads to patient distress and can be improved with better communication and patient education. While prior studies have suggested that patients often do not feel that they were fully prepared for surgery, little is known about exactly how preoperative expectations diverge from their surgical experience and postoperative course. OBJECTIVE: The aim of our study is to explore the surgical experience from a patient perspective, characterize areas of dissonance between expectations and reality, and identify opportunities to improve perioperative processes. METHODS: A mixed methods qualitative study was performed. Subjects included patients who were within 1 year status post an open, laparoscopic, or vaginal hysterectomy that included a pelvic floor reconstruction. Recruitment was performed between December 2022 and May 2024 from an ambulatory urogynecology office at a single academic institution. Subjects participated in a screening questionnaire followed by a 1:1 in-depth semi-structured interview aimed at eliciting candid and detailed responses about their surgical experience. The data was analyzed in a three-phase coding process using grounded theory methods to perform thematic analysis. RESULTS: Twenty-one patients were recruited. Five major themes emerged, including preoperative preparations, interpersonal interactions, perioperative stressors, postoperative expectations, and validation of surgical decision. Patient concerns prior to having surgery included fear of anesthesia, anxiety about voiding trials, and a baseline unease about recovery after surgery at an older age. Patients attributed their positive experiences to interpersonal interactions, including having good rapport and confidence in their surgeon, feeling comforted by nursing staff, learners, and APPs, and having a support person on the day of surgery. There appeared to be a number of aspects that patients found to be unexpected and stressful, including difficulty picking up medication from the pharmacy, short-staffed nursing on the hospital floors, and unanticipated postoperative pain such as dysuria, shoulder pain, bloating, and throat pain. There were mixed feelings toward whether or not the recovery was better or worse than expected. All patients agreed that after their surgical experience, they would recommend surgery to a friend with the same issue, and several stated that they wished they had done the surgery earlier. CONCLUSIONS: This study identified discrepancies between preoperative expectations and the patient perioperative experience. Recognizing these dissonances can inform better practices in surgical preparation. Improved patient education and communication are essential to reduce apprehension and fear surrounding surgical procedures. Future work should be directed toward improving preoperative counseling and setting expectations (Table 1).