The Importance of a Multidisciplinary Approach to Pelvic Floor Disorders

Abstract

Disorders of the female pelvic floor are common, negatively impact quality of life, and encompass a broad group of structural and functional diagnoses. Their variety is owed largely to the close anatomic relationships between the various organs in the female pelvis. Historically, the pelvic floor was described as consisting of three distinct compartments, each with its own responsible medical specialist. However, as our understanding of the natural history of pelvic floor disorders has evolved, we have come to understand that many of these diagnoses share common etiologic factors and very often coexist. This understanding has prompted development of a model of multidisciplinary care for patients with pelvic floor disorders which is quickly gaining attention around the world for its patient-centered approach to care. The model may also improve research recruitment, help with standardization of terminology across medical specialties, and improve the efficiency and accuracy of workup and diagnosis. Therefore, what has historically been a siloed approach to pelvic floor disorders may better serve patients and providers if restructured into a cohesive, multispecialty model.

Commentary by Jason Kim, Women’s Pelvic Health and Continence Center, Stony Brook University Hospital, Department of Urology, Stony Brook, NY, USA

Commentary

• Jason Kim 

In this chapter, the authors present a challenging case of a woman with multiple pelvic floor disorders (PFDs) who continues to experience significant symptoms which may be coexistent and/or resultant from her previous treatment. As suggested by the authors, this patient would benefit from evaluation by multiple specialties including urology, gynecology, gastroenterology, colorectal surgery, pelvic floor physical therapy, and female pelvic medicine and reconstructive surgery. The authors discuss the multiple benefits of a multidisciplinary approach including accuracy of diagnosis, efficiency of workup, appropriateness of interventions, patient quality of life, and patient satisfaction. Multidisciplinary care has been successfully implemented for conditions including cancer, breast care, wound care, and diabetes. PFDs would be an ideal target for multidisciplinary care as patients often suffer complex dysfunction of multiple organ systems.

The ideal setting to care for these patients would be a single center incorporating the multiple specialties listed above. Creating a “home” for PFD patients would increase patient access to multiple specialists. Patients with multiple PFDs often have difficulty navigating their treatment in the traditional compartmentalized “silo” approach. Previous studies have demonstrated that patients’ health literacy for PFDs is limited, and our institution has previously shown that patient follow-up rates for OAB (a representative PFD) treatment are poor. Patients often get lost in the shuffle and may be offered incomplete treatment by a single specialist in the traditional model.

Despite the multiple advantages of collaboration, very few of these centers exist nationally. Madjar et al. [54] previously reported that 55.4% of gynecologists and 29.4% of urologists never collaborate in the OR for anti-incontinence or pelvic floor reconstructive procedures. Often there is competition, and turf battles among the different specialties and collaborative care may lead to perceived loss of control for the physician. Physicians must realize that multidisciplinary input is essential for optimal patient care. In Madjar’s study cited above, two thirds of gynecologists and one third of urologists who did not collaborate in the OR believed they possessed sufficient expertise all by themselves.

A study of collaboration in clinical practice reported that providers’ collaboration across all contexts was hampered by organizational and individual factors, including differences in professional power, knowledge bases, and professional culture [55]. The lack of appropriate collaboration between providers impeded clinical work. Specialists in PFDs represent a diverse field of specialists and are no exceptions to these issues. As healthcare shifts toward value-based medicine and accountable care organizations, collaboration will become more critical, and PFD specialists should be cognizant of the issues impeding collaboration. In the end, patient care and satisfaction should improve with increased collaboration.