Mindful Decisions in Urogynecological Surgery: Paths from Awareness to Action

  • Joyce SchachterEmail author


Mindfulness is a key element in my urogynecology and reconstructive pelvic surgery practice. Working with a patient as therapeutic coach, we define the nature and severity of her problem, the boundaries of her knowledge, and the limits of her willingness to endure discomfort and imposition on her lifestyle when secondary health benefits are sacrificed. Mindfulness opens possibilities of engagement with patients on emotional as well as intellectual levels, and promotes shared decision making as a result of a partnership where each party makes unique contributions. Mindful surgical planning motivates physicians to offer medical expertise, professional perspective, and their personal experience to the consultation. It empowers patients to bring their personal experience, cultural perspective, and current understanding to determine elective interventions at their own pace and increases patient satisfaction with outcome.


Mindful surgical practice Reconstructive pelvic surgery Patient-centered decision making Decision-making women’s health 


  1. 1.
    Kabat-Zinn J. Wherever you go there you are: mindfulness meditation in everyday life. New York: Hyperion; 1994.Google Scholar
  2. 2.
    Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Delta; 1991.Google Scholar
  3. 3.
    Santorelli S. Heal thy self: lessons on mindfulness in medicine. New York: Bell Tower; 2000.Google Scholar
  4. 4.
    Hahn TN. Peace is every step: the path of mindfulness in everyday life. New York: Bantam Books; 1992.Google Scholar
  5. 5.
    ACOG Committee Opinion. Surgery and patient choice: the ethics of decision making. Obstet Gynecol. 2003; 102(5 Pt 1):1101–6.Google Scholar
  6. 6.
    Barry MJ, Edgeman-Levitan S. Shared decision making—the pinnacle of patient centered care. NEJM. 2012;366:780–1.PubMedCrossRefGoogle Scholar
  7. 7.
    Engle DE, Arkowitz H. Ambivalence in psychotherapy: facilitating readiness to change. New York: Guilford; 2006.Google Scholar
  8. 8.
    Miller WR, Rollnick SR. Motivational interviewing: preparing people for change. 2nd ed. New York: Guildford; 2002.Google Scholar
  9. 9.
    Al-Badr A. Quality of life. Questionnaires for the assessment of pelvic organ prolapse: use in clinical practice. Urology. 2013;5(3):121–8.Google Scholar
  10. 10.
    Schurch B, Denys P, Kozma CM, Reese PR, Slaton T, Barron R. Reliability and validity of the incontinence quality of life questionnaire in patients with neurogenic urinary incontinence. Arch Phys Med Rehabil. 2007;88(5):646–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Gee RE, Corry MP. Patient engagement and shared decision making in maternity care. Obstet Gynecol. 2012;120(5):995–7.PubMedGoogle Scholar
  12. 12.
    O’Connor A, Rostom A, Fiset V, Tetroe J, Entwistle V, Llewellyn-Thomas H, Holmes-Rovner M, Barry M, Jones J. Decision aids for patients facing health treatment or screening decisions: a Cochrane systematic review. BMJ. 1999;319(7212):731–4.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    O’Connor AM, Drake ER, Wells GA, Tugwell P, Laupacis A, Elmslie T. A survey of the decision-making needs of Canadians faced with complex health decisions. Health Expect. 2003;6(2):97–109.PubMedCrossRefGoogle Scholar
  14. 14.
    Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, et al. The international patient decision aids standards (IPDAS) collaboration. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333(7565):417.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    O’Connor A, Wennberg J, Légaré F, Llewellyn-Thomas H, Moulton B, Sepucha K, Sodano A, Staples King J. Towards the tipping point: accelerating the diffusion of decision aids that help patients to weigh benefits versus risks. Health Aff. 2007;26(3): 716–25Google Scholar
  16. 16.
    Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014 (1). Art. No. CD001431. doi:10.1002/14651858.CD001431.pub4:1–4.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Harmony HealthOttawa HospitalOttawaCanada

Personalised recommendations