In Office Versus Telemedicine Preoperative Visit: a Randomized Controlled Trial
Phase: NA
Conditions: Telemedicine
Sponsor: Wake Forest University Health Sciences

 
Protocol Version Number: 2 
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STUDY TITLE 
 
In Office versus Telemedicine Preoperative Visit: A Randomized Controlled Trial 
 
PRINCIPAL INVESTIGATOR 
 
Elizabeth Braxton, MD 
2001 Vail Avenue, Suite 360 
Charlotte, NC 28207 
803-261-3377 
 
CO-INVESTIGATORS 
 
Megan Tarr, MD 
200 Medical Park Drive, Suite 250 
Concord, NC 28025 
704-403-6350 
 
Erinn Myers, MD 
2001 Vail Avenue, Suite 360 
Charlotte, NC 28207 
704-304-1160 
 
 
Sarah Evans, MD 
2001 Vail Avenue, Suite 360 
Charlotte, NC 28207 
 
STUDY OBJECTIVES 
 
PRIMARY OBJECTIVE 
To determine whether preoperative telemedicine appointments are non-inferior to in-
office visits based on patient preoperative preparedness in women undergoing pelvic 
surgery as measured by a preoperative preparedness survey.   
 
SECONDARY OBJECTIVES 
1. Evaluate patient satisfaction using the S-CAHPS survey 
2. Calculate the duration of visit for patient (minutes) 
3. Calculate the duration of visit for provider (minutes) 
4. Estimate round trip travel distance from patient home to clinic (miles) 
5. Evaluate the number of office contacts from date of preoperative counseling to 6 
weeks postoperatively.  
a. Patient initiated calls 
b. Nurse initiated calls 

 
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c. Scheduled office visits 
d. Add on office visits 
6. Evaluate canceled, no-show, and late visits  
7. Calculate value proposition metrics for Atrium Health System 
 
HYPOTHESIS 
Telemedicine visits will be non-inferior to in-office visits in readying patients for surgery 
based on a preoperative preparedness survey. Additionally, we hypothesize that women 
will be equally satisfied with telemedicine preoperative visits as compared to in-office 
preoperative visits.  
 
BACKGROUND 
Preoperative patient education is an important perioperative element– facilitating 
expectation-setting, patient preparedness and the patient-surgeon relationship. The 
preoperative visit is traditionally a necessary in-office examination and counseling visit 
between a patient and surgeon prior to a scheduled surgical procedure. However, office 
visits incur additional time and travel costs to patients, which may be particularly 
burdensome to those with limited resources and those who live far from the office (1). 
In-office visits also require medical office resources such as an examination room, 
supplies, nursing staff and provider time. At the Women’s Center for Pelvic Health, 
patients are scheduled for a preoperative medical clearance visit with the Carolinas 
Hospitalist Group in addition to a preoperative counseling visit in our office. Sometimes 
these visits are scheduled on different days resulting in increased travel and time 
requirements for our patients.  
 
Patient counseling and patient-physician communication resources have expanded 
concurrent with technologic advancements. The Health Resources and Services 
Administration (HRSA) of the U.S. Department of Health and Human Services defines 
telehealth as the use of electronic information and telecommunications technologies to 
support and promote long-distance clinical health care, patient and professional health-
related education, public health and health administration (2). Telemedicine 
communication technology is already being used in multiple medical fields including 
radiology, anesthesiology, internal medicine, and various surgical specialties (3-9). 
Patients report no difference in satisfaction when telemedicine is used for pre-
anesthesia evaluations as compared to in-person evaluation. Additionally, no operative 
delays were noted on the day of surgery in these telemedicine-evaluated patients (7).  
Several general surgery pilot studies have also demonstrated that telemedicine 
postoperative visits are safe, efficient, improve patient satisfaction, and increase 
hospital revenue (8,9). 
 
More studies are needed to evaluate perioperative telemedicine use for Female Pelvic 
Medicine and Reconstructive Surgery (FPMRS) patients. Women presenting to FPMRS 
clinics are excellent candidates for telemedicine visits as they often have internet access 

 
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and a desire to learn about their condition outside of the office setting through websites 
and social media (10,11). A recent randomized controlled trial revealed that telephone 
calls for postoperative follow up after surgical management of pelvic floor disorders 
resulted in non-inferior patient satisfaction without differences in clinical outcomes or 
adverse events (12). No studies to date evaluate FPMRS patient preoperative 
preparedness following a preoperative telemedicine visit.  Further investigating this 
communication modality specific to our patient population needs will enhance our 
ability to provide evidence-based, patient-centered perioperative care.  
 
STUDY DESIGN AND METHODS 
This is a randomized controlled trial offered to patients who require a preoperative visit 
prior to scheduled pelvic reconstructive surgery at our institution. The study will be 
conducted at the Women’s Center for Pelvic Health (WCPH) Mercy Hospital, Atrium 
Health, Charlotte, NC. 
 
HUMAN SUBJECT RESEARCH AND INFORMED CONSENT 
Each participant will be required to give verbal consent prior to beginning any study-
related interventions or assessments. The verbal consent script will describe the study in 
detail and will disclose the planned uses of study data as well as potential risks to the 
participants. Each prospective subject will have the objectives of the study explained to 
them prior to enrollment. The subject will be given an opportunity to ask questions and 
decide whether or not to participate.  
 
Subjects have the right to:  
 
Voluntarily participate in the study 
 
Withdraw or refuse participation in the study at any point without questioning 
 
Understand the objective of the study 
 
Understand the risks and benefits of the study 
 
Have their confidentiality maintained 
 
PARTICIPANT SCREENING AND ENROLLMENT 
Patients who are planning to schedule pelvic reconstructive surgery with Women’s 
Center for Pelvic Health and require a preoperative visit will be identified and screened 
against inclusion and exclusion criteria. If patients meet the requirements for the study, 
they will be invited to participate in the study. The patients who do not meet inclusion 
criteria will be documented. Patients who decline to participate will be documented and 
reason will be noted. Participants will be consented for enrollment into the study by 
physicians, fellow physicians, and/or the research team prior to surgery. Participants will 
be randomized to one of the two counseling groups at the time of verbal consent.  
 
PROVIDER AND CLINICAL STAFF TRAINING  
To ensure consistent scheduling and counseling, the principal investigator will provide 
in-service education to all participating providers and clinical staff who will be 

 
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scheduling and performing preoperative visits. All clinical staff, including nurses, 
schedulers, and physicians, will receive in-service training about the study protocol and 
guidelines.  
 
INCLUSION CRITERIA 
1. Females age 18 and greater 
2. Visit location in North Carolina (or South Carolina during COVID) 
3. Planning to undergo pelvic surgery at Mercy Hospital, One Day Surgery Center, or 
CMC Main Hospital. 
4. Scheduled for enhanced recovery perioperative protocol 
5. Require a preoperative visit 
6. Access to internet and a virtual visit capable device 
7. Telephone access  
 
EXCLUSION CRITERIA 
1. Non-English speaking 
2. Inability to provide consent/decisionally impaired 
3. Auditory impairment 
4. Required preoperative in-office procedure such as endometrial biopsy 
 
STUDY WITHDRAWAL 
Participants may withdraw from the study at any point in time. Documentation of the 
reason for withdrawal will be captured in the data collection forms. There will be no risk 
to participants that choose to withdraw from the study.  
 
PREOPERATIVE PERIOD 
All consecutive patients planning to undergo pelvic surgery who require a preoperative 
visit will be identified, screened, and approached for participation in the study. 
Participants who do not meet the inclusion and exclusion criteria will be considered 
screen failures. Screen failures will be captured and the cause for screen failure will be 
documented.  
 
Verbal consent will be obtained and accurate email address will be confirmed. Eligible 
subjects will be randomized using a computer-generated randomization scheme with 
patients assigned in a 1:1 ratio to either:  
 
Study Group: Telemedicine preoperative counseling with an FPMRS fellow  
 
Control Group: Standard in-office preoperative counseling with an FPMRS fellow 
 
The allocation sequence will be in numerical, sealed, opaque envelopes. An envelope 
will be retrieved at the time of consent. The surgical scheduler will schedule the patient 
for their allocated preoperative visit.  

 
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Prior to their preoperative visit, participants will be emailed copies of the office ERAS 
informational booklet and International Urogynecology Association (IUGA) patient 
information handouts pertinent to their surgery.  The preoperative visit at Women’s 
Center for Pelvic Health is a counseling visit to review informed consent. Preoperative 
medical evaluation is accomplished through the Carolinas Hospitalist Group 
preoperative clinic or with the patient’s primary care provider. Patients who require 
preoperative medical clearance will be scheduled for a preoperative visit with the 
Carolinas Hospitalist Group or their primary care provider in addition to their 
preoperative visit with the Women’s Center for Pelvic Health. These visits will be 
documented in the total office visit data collection.  
 
Women in the Telemedicine group will check in for their preoperative visit via an Atrium 
Information Systems (IS) approved virtual communication platform at the scheduled 
date and time. They will undergo preoperative counseling following a standardized 
checklist format. After telemedicine counseling has concluded, participants will be 
emailed a REDCap survey link to complete a survey regarding their preparation for 
surgery. (See Figure 2) If a participant has not completed the survey by the next 
business day, an email reminder will be sent to their email address on file. If they have 
not completed the survey within 2 business days, they will be contacted by phone for 
reminder or survey will be obtained in the preoperative area on day of surgery. If a 
participant in the Telemedicine group ultimately elects to have an in-office preoperative 
visit, they will be scheduled for in-office visit and analyzed as intention-to-treat.   
 
Women in the In-office group will present to WCPH for preoperative in-person 
counseling following a standardized checklist format. After in-office counseling has 
concluded, participants will be asked to complete a survey regarding preparation for 
surgery via a REDCap survey link on an Atrium IS approved iPad prior to leaving the 
office. (See Figure 2) If for any reason the patient did not complete the survey prior to 
leaving the office, the survey will be emailed to them in similar fashion as the 
telemedicine group.  
 
PERIOPERATIVE PERIOD 
Participants will present to Mercy Hospital, One Day Surgery Center, or CMC Main 
Hospital for their scheduled surgery. All participants will receive routine care according 
to the gynecologic enhanced recovery perioperative protocol. The gynecologic 
enhanced recovery perioperative protocol is a multimodal perioperative care pathway 
designed to achieve early recovery after surgery by maintaining preoperative organ 
function and reducing the physical stress of surgery on the body. This protocol includes 
many components including allowing patients to drink clear liquids up to 3 hours prior 
to their surgery, maintaining euvolemia intraoperatively, and early return to normal diet 
and activity after surgery. All patients undergoing pelvic reconstructive surgery are 

 
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scheduled for the enhanced recovery protocol, except for women having only minor 
procedures such as mid-urethral sling placement or cystoscopy.  
 
 
POSTOPERATIVE PERIOD 
All participants will undergo routine postoperative care. They will be scheduled for an 
in-office or virtual postoperative visit, on average 1-2 weeks after surgery and then an 
in-office visit at 6 weeks after surgery per our office standard practice. Following their 2-
week postoperative visit, women will be asked to complete the preoperative subsection 
of the Surgical-CAHPS survey to evaluate patient satisfaction. This will be given to all 
patients in paper format prior to leaving the office or emailed to them via REDCap 
survey link. If a patient does not present to their 2-week postoperative appointment, 
they will be emailed a copy of the preoperative subsection of the S-CAHPS and this will 
be automatically uploaded into REDCap when submitted by the participant.  
 
Following the 6 week postoperative visit, secondary data will then be extracted from the 
EMR via manual chart view.  
 
RANDOMIZATION 
An Atrium Health biostatistician will generate a randomization sequence using SAS 
Enterprise Guide 6.1. A permuted block randomization scheme will be used to assign 
patients in a 1:1 ratio to Telemedicine visit or In-office visit.  
 
The study will not be blinded.  
 
DATA COLLECTION AND MANAGEMENT 
 
Data Collection Schedule 
Case report forms will be developed by the investigators. Data will be collected 
prospectively per the schedule in Table 1. All study data will be recorded by 
research staff and securely maintained at the Mercy study site. The data flow will 
consist of paper data collection for eligibility assessment, baseline data, 
randomization, intervention group, primary and secondary outcomes, and 
protocol deviations.  
 
Data will be entered by study staff into REDCap database that will be stored on a 
secure server at Atrium Health. Web-based survey responses will be linked to 
REDCap for automatic entry following participant submission of surveys. REDCap 
(Research Electronic Data Capture) is a secure, web-based application designed 
to support data capture for research studies providing: 1) an intuitive interface 
for validated data entry; 2) audit trails for tracking data manipulation and export 
procedures; 3) automated export procedures for seamless data downloads to 
common statistical packages; and 4) procedures for importing data from external 
sources (13).  

 
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Each patient will have a unique identification number to which only the principal 
and sub-investigators will have access. The data collection spreadsheet will not 
contain any patient identifiers and will be password protected. The master list 
that links the patients and their study information will be stored separately on a 
password protected hard drive. A back up copy of the file will be stored on a 
password protected hospital network drive. All hard copies of study data will be 
stored in a locked cabinet in the office of the research nurse, which will also be 
locked.  
 
Table 1. Data Collection Schedule 
 
Prior to 
Preoperative 
visit 
Preoperative 
visit 
Period 
between 
Preop visit 
and surgery 
Surgery 
2 week postop 
visit 
6 week 
postop visit 
Informed consent 
X 
 
 
 
 
 
Randomization 
X 
 
 
 
 
 
Travel distance 
X 
 
 
 
 
 
Internet Access/Usage 
X 
X 
 
 
 
 
Other Demographics* 
X 
X 
 
 
 
 
Patient Preparedness 
 
X 
 
 
 
 
Patient Satisfaction 
 
 
 
 
X 
 
Office visits 
 
X 
X 
 
X 
X 
 Cost metrics 
 
 
 
 
 
X 
 
*Other demographic data includes: Age, Race, Education level, Health literacy score, 
and number of prior surgeries. 
 
 
Source of records to be reviewed 
 
 
- Canopy EMR (electronic medical record) 
- Preoperative Preparedness Survey 
- S-CAHPS survey 
 
 
Confidentiality of data 
Electronic data will be stored to safe-guard confidentiality using a password 
protected computer. Principal investigator, Co-Investigator, Research 
Coordinator nurse, and Statisticians will have access to harvested patient data. 
Harvested patient data will be stored until final statistical analysis completed and 
manuscript accepted and published.  
 
OUTCOME MEASURES 
 
Primary Outcome Measure 
a. Patient Preoperative Preparedness: Participants will complete a 
Preoperative Preparedness Survey following the preoperative visit. This will 
be graded on a 6-point Likert scale with responses ranging from “Strongly 

 
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Agree” to “Strongly Disagree”.  The summary score of 11 items will be 
calculated as the measurement of primary outcome. See Figure 2.  
 
Secondary Outcome Measure 
a. Patient Satisfaction: Patients will complete the preoperative portion of the 
Consumer Assessment of Healthcare Providers and Systems Surgical Care 
Survey (S-CAHPS) following the 2-week postoperative visit. S-CAHPS is a 
validated standardized questionnaire for adults developed by the American 
College of Surgeons (ACS) and other surgical specialty societies to assess 
patients’ experiences before, during, and after surgery. The preoperative 
portion of this survey includes questions regarding Patient Satisfaction, 
Physician Communication, and Shared Decision Making. See Figure 3.  
b. Duration of visit: Each preoperative visit will be timed to evaluate patient 
and provider visit duration. Timing will begin for the Telemedicine group 
upon connection to the virtual waiting room and will conclude after all 
counseling is completed and the virtual visit is disconnected. The duration of 
virtual visit counseling time with the provider will also be calculated. Timing 
for the in-office group will begin at time of patient check-in at the front desk 
and will conclude with patient check-out.  
c. Miles patient traveled: Round trip travel distance from patient’s home 
address to office will be evaluated via a HIPPA compliant map-based search 
engine for each participant.   
d. Office contacts: The total number and type of office contact between the 
preoperative visit and the 6-week postoperative visit will be collected via 
manual chart review. Type of office contact visits include patient-initiated 
calls, nurse-initiated calls, scheduled office visits, and add-on office visits. 
e. Canceled, No-show, and late visits: If patients call to cancel their 
appointment this will be considered a canceled preoperative visit. 
Rescheduled appointment will be noted. Patients who arrive to their visit 
later than 10 minutes will be considered late for each group. If patients do 
not present for their visit, it will be considered a No-show appointment.  
f. Calculated value proposition metrics: The length of visit will be compared 
between groups. Office schedules will be analyzed and will determine the 
percentages of new patient visits and preoperative visits. If preoperative 
visits are replaced with new patient visits over a month, based on 
institutional data, anticipated new operative cases and projected revenue 
impact on the health care system will be determined. Costs of video based 
virtual visit platform will also be calculated.  
 
STATISTICAL CONSIDERATIONS 
 
Statistical Methods 
The primary analysis will compare summary scores of preparedness between 
both study groups. Non-inferiority of virtual visit compared with in-person visit 

 
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would be claimed if the upper limit of the one-sided 95% confidence interval for 
the mean differences of scores between two groups will not exceed the pre-
specified margin of 9 points. Descriptive statistics will be calculated to assess 
level of preparedness for each question. Secondary outcomes, demographics, 
and other baseline variables will be compared between the two groups using the 
Chi squared test or Fisher’s exact test for categorical data, Student’s t test for 
normally distributed data, and the Wilcoxon rank sum test for ordinal data or 
continuous data that are not normally distributed.  
 
 
Sample Size Calculation 
Sample size calculations were based on two-group non-inferiority comparisons 
of patient preoperative preparedness for surgery using two-sample t-test. The 
following assumptions were made: the margin of non-inferiority is 9.0 and the 
data are drawn from populations with standard deviations of 15.0. A sample size 
of 45 in each arm is needed to achieve a power of 0.8 with α=0.025.  Considering 
a 30% drop out rate, we will require 59 patients in each group and a total of 118 
participants. The power was calculated by using the PASS 15 (2017, NCSS, LLC. 
Kaysville, Utah, USA). 
 
STUDY DOCUMENTATION AND MONITORING 
 
Documentation 
All study documents included in this protocol that will be presented to subjects 
will be submitted to the IRB for review. The site will maintain a study binder that 
will include the following:  
 
- 
Enrollment log of patients that have consented to be in the study 
(electronic version) 
- 
Protocol deviation log (electronic version) 
- 
Adverse event log (electronic version) 
- 
Investigator protocol and amendments 
- 
IRB submissions, modifications, and renewals 
- 
Data safety monitoring committee reports 
- 
IRB approved verbal consent forms 
- 
Data collection forms 
 
Study Monitoring 
The Principal Investigator will monitor the study and assess the need for 
amendments as the study progresses. The PI will review the progress of each 
subject on the study and will apprise the IRB of adverse events or unexpected 
problems that may influence the IRB’s decision to allow the trial to continue, in 
accordance with the IRB’s standard operating procedures and policies. A 
protocol revision may be necessary for reasons including but not limited to 
rights, confidentiality of participants, welfare of participants, and thus, an 

 
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amendment will be required. Appropriate approvals (i.e., IRB) of the revised 
protocol must be obtained prior to implementation.  
 
An independent, external physician will be appointed to serve as the Data safety 
monitor and will review the study data every 6 months.  Data and safety 
monitoring responsibilities will consist of review of the research protocol and 
ongoing study activities, including review of data quality and completeness, 
review of fidelity to the study protocol, review of adequacy of participant 
recruitment and retention, review of adverse events, and making 
recommendations to the study PI and to the IRB concerning trial continuation, 
modification, or conclusion. Such monitoring helps to safeguard subject safety, 
ensure data quality, and provide ongoing training and support to ensure 
compliance. The PI (Elizabeth Braxton, MD) will be responsible for ensuring that 
the study complies with the data safety monitors’ requests.  
 
Data Safety Monitoring 
Biannual reports detailing the study progress and subject status, any adverse 
events, and any protocol deviation will be submitted to the safety monitor for 
review. The research coordinator will inform all study staff members of any 
unanticipated problems involving risks to study subjects or others.  
 
 
Protocol Deviations 
Protocol deviations will be documented and logged on the Protocol Deviations 
log (electronic version). This will be done for every protocol related deviation 
related to any portion of the study timeline. Deviations will be reviewed and 
evaluated on an ongoing basis, and, as necessary, appropriate corrective and 
preventive actions (including notification, re-training, or discontinuation) will be 
put in place.  
 
References:  
 
1. Seidel JE, Beck CA, Pocobelli G, Lemaire JB, Bugar JM, Quan H, Ghali WA. Location of 
residence associated with the likelihood of patient visit to the preoperative assessment 
clinic. BMC Health Serv Res 2006;6:13. 
2. Health Resources and Services Administration. (https://www.hrsa.gov/rural-
health/telehealth/index.html) May 2019.  
3. LaMonte MP, Bahouth MN, Hu P, et al. Telemedicine for acute stroke: triumphs and 
pitfalls. Stroke. 2003; 34:725-728 
4. Platts-Mills TF, Hendey GW, Ferguson B. Teleradiology interpretations of emergency 
department computed tomography scans. J Emerg Med. 2010; 38:188-195.  
5. Asiri A, AlBishi S, AlMadani W, ElMetwally A, Househ M. The Use of Telemedicine in 
Surgical Care: a Systematic Review. Acta Inform Med 2018; Sept 26(3):201-206.  

 
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6. Applegate II R, Gildea B, Patchin R, Rook J, Wolford B, Nyirady J, Dawes TA, Faltys J, 
Ramsingh D, Stier G.  Telemedicine Pre-anesthesia Evaluation: A Randomized Pilot Trial. 
Telemedicine and E-health. 2013; 19: 211-216 
7. Lozada MJ, Nguyen J, Abouleish A, Prough D, Przkora R. Patient preference for the pre-
anesthesia evaluation: Telephone versus in-office assessment. Journal of Clinical 
Anesthesia (2016) 31, 145–148 
8. Nicolian V, Williams A, Jacobs B, Temp M, Wilson J, Mulholland M, Alam H. Pilot study to 
evaluate the safety, feasilbility, and financial implications of a postoperative 
telemedicine program. Ann Surg 2018; 268:700-707 
9. Soegaard Ballester J, Scott M, Owei L, Meylan C, Hanson C, Morris J. Patient preference 
for time-saving telehealth postoperative visits after routine surgery in an urban setting. 
Surgery 163 (2018) 672-679 
10. Myers EM, Rustowicz L, Wells D, Kidd JB, Jannelli ML, Connolly AM, Wu JM. Internet Use 
Among Urogynecology Patients in North Carolina. Female Pelvic Med Reconstr Surg 
2015;21: 269–272  
11. Mazloomdoost D, Kanter G, Chan R, Deveaneau N. Wyman A, VonBargen E, Chaudrrhy 
Z, Elshatanoufy S, Miranne J, Chu C, Pauls R, Arya L. Antosh D. Social networking and 
Internet use among pelvic floor patients: a multicenter survey.   
12. Thompson, J MD et al. Outpatient visits versus telephone interviews for postoperative 
care: A randomized controlled trial (OPTIONS). [abstract] In: Proceedings of the 39th 
Annual Scientific Meeting of the American Urogynecologic Society; 2018 Oct 9-13; 
Chicago, IL Paper nr 1 
13. Harris PA, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture 
(REDCap)- a metadata-driven methodology and workflow process for providing 
translational research informatics support. J Biomed Inform. 2009 Apr; 42(2):377-81.] 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Figure 1: Consort Flow Diagram 
 
 
 
 
 

 
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Figure 2: Preoperative Preparedness Survey  
 
 
 
 
 
 
Your Privacy is Protected. All information that would let someone identify you or your 
family will be kept private. The Women’s Center for Pelvic Health will not share 
your personal information with anyone. Your responses to this survey are also 
completely confidential.  
  
Your Participation is Voluntary. You may choose to answer this survey or not. If you 
choose not to, this will not affect the health care you get. 
  
What To Do When You’re Done. Once you complete the survey, please click the submit 
button.  Your survey will be saved to our secure database.  
  
If you want to know more about this study, please call Elizabeth Braxton, MD at 803-
261-3377 or email at Elizabeth.braxton@atriumhealth.org  
 
Survey Instructions 
Answer each question by clicking the box to the left of your answer. When you have 
selected your desired response, please click “Next”.  
1
 Yes 
2
 No 
 
 
 

 
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1. I know about the Alternatives to the planned surgery.  
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
  
2. I understand the Purpose of the planned surgery (what this surgery can accomplish).  
1
 Strongly agree 
2
 Agree 
3
   Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
3. I understand the Benefits of the planned surgery (how this surgery should help me).  
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
4. I understand the Risks of the planned surgery (what are the chances of something not 
going the way my doctor and I want it to go?).  

 
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1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
 
 
5. I understand the Complications of the planned surgery (what problems can come 
from this surgery?). 
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
6. I feel prepared about what to expect after surgery while I am in the hospital.  
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
7. I feel prepared about what to expect after surgery when I am at home.  
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
8. I feel prepared to cope with a catheter after the surgery while I am at the hospital.  

 
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1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
 
 
9. I feel prepared to cope with a catheter after the surgery when I am at home.  
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
10. My doctors and nurses have spent enough time preparing me for my upcoming 
surgery.  
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
11. Overall, I feel prepared for my upcoming surgery.   
1
 Strongly agree 
2
 Agree 
3
 Somewhat agree 
4
 Somewhat disagree 
5
 Disagree 
6
 Strongly disagree 
 
 
 

 
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Think about the type of preoperative visit you had prior to your surgery.  
12. Please select the type of visit you had:  
1
 In-office visit 
            2
 Virtual visit 
 
 
13. How satisfied are you with the visit that you had before your surgery?  
1
 Very satisfied 
2
 Satisfied 
3
 Neither satisfied or dissatisfied 
4
 Not satisfied  
5
 Very dissatisfied  
 
14. How would you rate the level of convenience of the visit (virtual or in-person)? 
1
 Very convenient 
            2
 Convenient 
            3
 Neither convenient or inconvenient 
            4
 Not convenient  
            5
 Very inconvenient 
 
15. If you need to have surgery in the future, would you like to have this type of visit 
again?  
1
 Yes 
2
 No 
3
 Not sure 
 
16. Would you recommend the type of visit you had to a friend?  
1
 Yes 
2
 No 
3
 Not sure  
 
17. If in the future our clinic offered the option to have a preoperative visit using virtual 
visit technology or an in-person clinic visit, which would you prefer?  

 
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1
 Virtual visit 
            2
 In-person clinic visit 
            3
 No preference 
 
 
 
 
 
 
18. What types of technology have you used in the past to access health care services or 
personal health information? Select all that apply:  
         1
 Video conferencing (virtual visit)  
             2
 Email  
             3
 Text messaging 
             4
 Patient Portal (e.g. My Carolinas) 
             5
 Mobile health (accessing health services of personal health data via mobile devices)  
         6
 Other: ___________________________________________  
             7
 None  
 
 
 
 
 
 
 
 
 
The following questions will help us determine comfort level with health information.  
 
19. How often do you have someone (like a family member, friend, hospital/clinic 
worker, or caregiver) help you read hospital materials?  
 
1
 None of the time 
2
 A little of the time 
3
 Some of the time 
4
 Most of the time 
5
 All of the time 
 
 

 
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20. How often do you have problems learning about your medical condition because of 
difficulty understanding written information?  
 
1
 None of the time 
2
 A little of the time 
3
 Some of the time 
4
 Most of the time 
5
 All of the time 
 
 
21. How confident are you filling out forms by yourself?  
 
1
 Extremely 
2
 Quite a bit 
3
 Somewhat 
4
 A little bit 
5
 Not at all 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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Figure 3. Postoperative visit survey 
 
 
 
 
 
 
Your Privacy is Protected. All information that would let someone identify you or your 
family will be kept private. The Women’s Center for Pelvic Health will not share 
your personal information with anyone. Your responses to this survey are also 
completely confidential.  
  
Your Participation is Voluntary. You may choose to answer this survey or not. If you 
choose not to, this will not affect the health care you get. 
  
What To Do When You’re Done. Once you complete the survey, please return the 
survey to your nurse.  
  
If you want to know more about this study, please call Elizabeth Braxton, MD at 803-
261-3377 or email at Elizabeth.braxton@atriumhealth.org  
  
Survey Instructions 
Answer each question by clicking the box to the left of your answer. When you have 
selected your desired response, please click “Next”.  
1
 Yes 
2
 No 
 

 
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1. Before your surgery, how many visits did you have with your surgeon and their 
assistant surgeons?  
1
 None 
2
 1 visit 
3
 2 visits 
4
 3 visits 
5
 4 to 6 visits 
6
 7 or more visits 
  
2. A health provider could be a doctor, nurse, or anyone else you would see for health 
care. Before your surgery, did anyone in your surgeon’s office give you all the 
information you needed about your surgery?  
1
 Yes, definitely 
2
 Yes, somewhat 
3
 No 
3. Before your surgery, did anyone in your surgeon’s office give you easy to understand 
instructions about getting ready for your surgery?  
1
 Yes, definitely 
2
 Yes, somewhat 
3
 No 
4. During your visits before your surgery, did your surgeon or their assistant surgeon tell 
you there was more than one way to treat your condition?  

 
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1
 Yes 
2
 No 
5. During your visits before your surgery, did your surgeon or their assistant surgeon ask 
which way to treat your condition you thought was best for you? 
1
 Yes 
2
 No  
 
 
 
 
6. During your visits before your surgery, did your surgeon or their assistant surgeon 
talk with you about the reasons you might want to have the surgery?  
1
 Not at all 
2
 A little 
3
 Some 
4
 A lot 
7. During your visits before your surgery, did your surgeon or their assistant surgeon 
talk with you about the reasons you might not want to have the surgery? 
1
 Not at all 
2
 A little 
3
 Some 
4
 A lot  
8. During the visits before your surgery, did your surgeon or their assistant surgeon 
listen carefully to you? 
1
 Yes, definitely 
2
 Yes, somewhat 
3
 No  
9. During your visits before your surgery, did your surgeon or their assistant surgeon 
spend enough time with you?  

 
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1
 Yes, definitely 
2
 Yes, somewhat 
3
 No  
10. During your visits before your surgery, did your surgeon or their assistant surgeon 
encourage you to ask questions?  
1
 Yes, definitely 
2
 Yes, somewhat 
3
 No  
 
 
 
 
11. During your visits before your surgery, did your surgeon or their assistant surgeon 
show respect for what you had to say?  
1
 Yes, definitely 
2
 Yes, somewhat 
3
 No  
12. During your visits before your surgery, did anyone in your surgeon’s office use 
pictures, drawings, models, or videos to help explain things to you? 
1
 Yes 
2
 No  
13. Did these pictures, drawings, models, or videos help you better understand your 
condition and its treatments?  
1
 Yes, definitely 
2
 Yes, somewhat 
3
 No, these were not helpful.  
4
 No, my surgeon’s office did not use these.  
 
 

 
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Think about the type of preoperative visit you had prior to your surgery.  
14. Please select the type of visit you had:  
          1
 
In-office visit 
          2
 
Virtual visit 
 
 
15. How satisfied are you with the visit that you had before your surgery?  
1
 Very satisfied 
2
 Satisfied 
3
 Neither satisfied or dissatisfied 
4
 Not satisfied  
5
 Very dissatisfied  
 
16. How would you rate the level of convenience of the visit (virtual or in-person)? 
            1
 Very convenient 
            2
 Convenient 
            3
 Neither convenient or inconvenient 
            4
 Not convenient  
            5
 Very inconvenient 
 
17. If you need to have surgery in the future, would you like to have this type of visit 
again?  
1
 Yes 
2
 No 
3
 Not sure 
 
18. Would you recommend the type of visit you had to a friend?  
1
 Yes 
2
 No 
3
 Not sure  
 
19. If in the future our clinic offered the option to have a preoperative visit using virtual 
visit technology or an in-person clinic visit, which would you prefer?  

 
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1
  Virtual visit 
            2
 In-person clinic visit 
            3
 No preference 
 
 
 

 
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