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Optimal Pessary Care: A Modified Delphi Consensus Study

Hooper, Gwendolyn L. ; Atnip, Shanna ; O' Dell, Katharine

Journal of Midwifery & Women's Health, July 2017, Vol.62(4), pp.452-462 [Periódico revisado por pares]

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  • Título:
    Optimal Pessary Care: A Modified Delphi Consensus Study
  • Autor: Hooper, Gwendolyn L. ; Atnip, Shanna ; O' Dell, Katharine
  • Assuntos: Consensus ; Delphi Technique ; Prolapse Treatment ; Provider Education ; Vaginal Pessary
  • É parte de: Journal of Midwifery & Women's Health, July 2017, Vol.62(4), pp.452-462
  • Descrição: Byline: Gwendolyn L. Hooper, Shanna Atnip, Katharine O'Dell Keywords: consensus; Delphi technique; prolapse treatment; provider education; vaginal pessary Introduction Support pessaries are an important, low-risk treatment option for women with vaginal prolapse but evidence to inform optimal practice is lacking. Currently, gynecologists, urologists, and urogynecologists recommend silicone vaginal support pessaries as first-line treatment for symptomatic vaginal prolapse in women of all ages. It is unknown how many providers who are not physicians prescribe and care for women using pessaries. For this study we attempted to collect opinions of expert nurse providers who fit pessaries on topics related to pessary care and management in an effort to develop consensus to guide practice. Methods A 4-round modified Delphi technique was utilized and included one series of online surveys, 2 rounds of anonymous online questionnaires, and one series of face-to-face meetings at conferences. Respondents were invited to participate in all opportunities to provide opinion. For the first 3 rounds respondents were asked to rate statements on a 3-point scale, (agree, disagree, neutral) and provide written comments for those statements with which they did not agree. The goal of additional rounds was 80% agreement between participants, including no less than 6 nurse pessary experts. Results Greater than 80% consensus was achieved for 22 statements related to patient and provider education, terminology for documentation, pessary management, and follow-up care. Use of vaginal estrogen, antimicrobials, and prevention and management of mechanical injury were areas where no consensus was reached. Discussion Expert pessary providers were able to develop consensus recommendations to inform provider education and clinical care where the evidence base remains sparse. Areas where consensus was not achieved inform the future pessary-related research agenda needed to identify optimal cost-effective pessary care and educational methods for new pessary providers. Biographical information: Gwendolyn L. Hooper, PhD, FNP-BC, CUNP-BC, is an Assistant Professor in the graduate nursing program at The University of Alabama in Tuscaloosa. She is a urology nurse practitioner and president of the Society of Urologic Nurses and Associates (SUNA). Shanna Atnip, MSN, WHNP-BC, is a Women's Health Nurse Practitioner, practicing at Parkland Health & Hospital Systems in the Division of Urogynecology and Reconstructive Pelvic Surgery at The University of Texas Southwestern Medical Center in Dallas, Texas. Katharine O'Dell, CNM, PhD, WHNP-BC, recently retired from her position as Associate Professor of OB/GYN in the Division of Pelvic Medicine and Reconstructive Surgery at the University of Massachusetts Memorial Medical Center.

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