New vs old: descriptors can affect patients' surgical preferences

Objective The objective of the study was to determine whether the designation of a procedure as newer leads more patients to choose that procedure over 1 that is designated as older. Study Design Women with stress incontinence read two 1-page descriptions of surgical procedures for treatment of stress incontinence and were asked to indicate which of the 2 surgical procedures they would choose whether they were going to choose surgical treatment. Randomly for half the participants, a rectus fascia sling was described as being a newer procedure and a mesh sling as an older procedure. For the other half of participants, a mesh sling was described as older and a fascia sling as newer. All participants were also asked whether, in general, they considered that newer surgical procedures were better than older surgical procedures and why. Results Forty-eight women of mean age 57 years (range, 33-82) were interviewed. Thirty-two patients (68%) chose the newer procedure, and 35 (74%) chose the fascia procedure, both percentages higher than would be expected by chance. When fascia was presented as being the newer procedure, it was chosen over the older mesh by 22 of 24 patients (92%), whereas when fascia was presented as being the older procedure, it was chosen over the newer mesh by a smaller margin. The great majority of patients (79%) stated that newer procedures are better in general. Conclusions Our results suggest that the use of the words newer or older may overshadow other important information that physicians intend to convey during surgical counseling.