Research Paper
Factors influencing women’s decision making in hysterectomy

https://doi.org/10.1016/j.pec.2017.09.006Get rights and content

Highlights

  • This study explored how Australian women knew about hysterectomy.

  • Most women felt well-informed about their hysterectomy.

  • Women were more aware of the open abdominal approach.

  • Decisions were influenced by surgeon’s preference, recovery time, surgical risks.

Abstract

Objective

To explore factors influencing how well-informed women felt about hysterectomy, influences on their decision making, and on them receiving a less-invasive alternative to open surgery.

Methods

Online questionnaire, conducted in 2015–2016, of women who had received a hysterectomy in Australia, in the preceding two years.

Results

Questionnaires were completed by 2319/6000 women (39% response). Most women (n = 2225; 96%) felt well-informed about hysterectomy. Women were more aware of the open abdominal approach (n = 1798; 77%), than of less-invasive vaginal (n = 1552; 67%), laparoscopic (n = 1540; 66%), laparoscopic-assisted (n = 1303; 56%), and robotic approaches (n = 289; 12%). Most women (n = 1435; 62%) reported their gynaecologist was the most influential information source. Women who received information about hysterectomy from a GP (OR = 1.47; 95% CI 1.15-1.90), or from a gynaecologist (OR = 1.3; 95% CI 1.06-1.58), were more likely to feel better informed (p < 0.01).

Conclusion

This study is important because it helps clinicians, researchers and health policy makers to understand why many women still receive an open abdominal approach despite many learned societies recommending to avoid it if possible.

Practice implications

Additional information, or education about avoiding open abdominal approach where possible may lead to a greater number of women receiving less-invasive types of hysterectomy in the future.

Introduction

Hysterectomy (removal of the uterus) is the most commonly performed major gynaecological surgical procedure. Annually, approximately 30,000 women receive hysterectomies in Australia; 434,000 in the USA [1], [2].

In Australia in 2013–2014, 11,822 (38%) of hysterectomies were performed by total abdominal hysterectomy (TAH) through an open, abdominal incision, while less invasive approaches including vaginal hysterectomy (VH), total laparoscopic hysterectomy (TLH) and laparoscopic assisted vaginal hysterectomy (LAVH) accounted for 8928 (29%), 5117 (16%), and 5381 (17%) of hysterectomy procedures, respectively [1]. Hysterectomy may also be conducted robotically (RH), though this approach is not widely available in Australia.

Despite its popularity, TAH is associated with significantly worse postoperative quality of life, pain, longer hospital stay, and a longer recovery period than less invasive approaches [3], [4], [5]. Based on level I evidence from systematic and Cochrane reviews, the American College of Obstetricians and Gynecologists (ACOG), American Association of Gynecologic Laparoscopists (AAGL), Society of Gynecologic Oncology (SGO), European Society for Medical Oncology (ESMO), European Society for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO), and the Society of Obstetricians and Gynecologists of Canada (SOGC) have all published position statements and clinical guidelines supporting the use of less invasive alternatives to TAH for women with benign and malignant gynaecological conditions [6], [7], [8], [9], [10].

The aim of this study was to explore factors influencing how well-informed women felt about hysterectomy, influences on their decision making, and on them receiving a less-invasive surgical alternative to TAH.

Section snippets

Methods

We conducted an anonymous online survey of women who received a hysterectomy in Queensland, Australia in the preceding two years.

Results

The questionnaire was open between July 2015 and January 2016. Responses were received from 2319/6000 women (39% response rate). Women’s median age was 52 years (range, 21 years to 90 years). Detailed participant characteristics are shown in Table 1.

The most common reasons for receiving a hysterectomy were alleviating symptoms (n = 1706; 73.6%), solving a medical problem (n = 1513; 65.3%), and lifestyle (n = 1087; 46.9%). Avoiding cancer was nominated as a reason by 898 (38.7%), and treating cancer

Discussion

This study is important because it helps clinicians, researchers and health policy makers to understand how women form decisions about the surgical approach to hysterectomy. Gynaecologists are the main providers of information about hysterectomy and most women follow their gynaecologist’s advice. The surgeon’s preferred surgical approach was the most dominant factor influencing women’s decision on a surgical approach. However, women who were conscious about recovery time, body image or surgical

Funding

This work was supported by (competitive, externally peer reviewed) funding from the Australian Centre for Health Services Innovation (AusHSI, grant SG0015-000486). The funder played no part in the conduct of the research, or in writing of the paper.

Contribution to authorship

AO and MJ planned the study; all authors were involved in the design and development of the survey; NRA conducted data analysis. All authors contributed to drafting and critical review of the manuscript and all authors approved the final submitted version.

Disclosure of interests

AO is the founder and managing director of SurgicalPerformance Pty Ltd, an Australian, private company that provides surgeons with a platform for collection of surgical outcome data; AO received travel grants from the O.R. Company (Victoria, Australia) and was a consultant for Covidien (New South Wales, Australia). No other authors have conflicts of interest to declare.

Acknowledgements

We thank the women who participated in this study and allowed us to expand our understanding of their perceptions of hysterectomy.

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  • Cited by (6)

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