ORIGINAL ARTICLE Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders Lior Lowenstein & Mary P. FitzGerald & Kimberly Kenton & Yashika Dooley & Mike Templehof & Elizabeth R. Mueller & Linda Brubaker Received: 9 February 2007 / Accepted: 21 April 2007 / Published online: 12 May 2007 # International Urogynecology Journal 2007 Abstract The purpose of the study was to assess the relationship between self-expressed urogynecologic goals, symptoms, and treatment choice. Charts of women present- ing for urogynecology consultation were reviewed. Demo- graphics, diagnoses and responses to the pelvic floor distress inventory and medical, social, and epidemiologic aspects of aging questionnaires were recorded. Patients listed urogynecology goals before consultation. We catego- rized goals into five categories and then compared these categories by symptom type, severity, and treatment. Three hundred five women reported 635 goals (median 2, range 1–6). The number of goals listed per patient did not differ by age, race, comorbidities, or clinical diagnosis (p >0.05). The most frequent goal category was symptoms (67%), followed by information seeking (12%), lifestyle (11%), emotional (4%), and “other” (6%). Women selecting non- surgical treatment were more likely to list information seeking as primary goal than those who chose surgery (p =0.009). One third of participants expressed a primary non-symptom goal and were more likely to seek non-surgical therapy. Keywords Goals . Patient-reported outcomes . Pelvic floor disorders . Urinary incontinence . Pelvic organ prolapse . Outcome assessment Introduction Doctors are trained to assess and treat patients based on the symptoms and signs of their medical disorders. This paradigm has worked well for medical emergencies and cancers where prompt diagnosis and treatment are neces- sary for survival. This approach may not be appropriate for quality of life conditions such as pelvic floor disorders in which symptoms and signs are often multiple, do not correlate well with one another, [1–3], and may interact in unique ways to affect the activities of daily living. Previous study suggests that factors leading patients with pelvic organ prolapse to seek surgical care are not only related to symptom severity and duration but are also related to patient age and prior prolapse surgery [4]. Our previous work has shown that patient satisfaction is influenced more by the achievement of patient-stated goals than objective cure of either stress incontinence or pelvic prolapse [5, 6]. In fact, the accumulating evidence suggests that while information related to symptoms and bother/quality of life before and after treatment are important, they are likely to reflect only part of a patient’ s reality and may actually be missing the mark [2–4, 7, 8]. Often, women with pelvic floor disorders present to their physician with their own individualized goals and expectations, and it is important for the physician to clearly understand patient goals so as to plan interventions to help achieve those goals [7, 9]. Given the apparent importance of patient-expressed treatment goals, we undertook this analysis to understand the characteristics of those goals so that we can design treatments with the highest likelihood of achieving those goals and satisfying patients. Our primary objective was to describe self-expressed patient goals in women seeking care for urogynecologic Int Urogynecol J (2008) 19:81–84 DOI 10.1007/s00192-007-0390-0 DO00390; No of Pages L. Lowenstein (*) : M. P. FitzGerald : K. Kenton : Y. Dooley : M. Templehof : E. R. Mueller : L. Brubaker Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 South First Avenue, Bldg 104, Room 1004, Maywood, IL 60153, USA e-mail: llowenstein@lumc.edu