How well informed do women feel about hysterectomy options?

Posted in hysterectomy; Posted 6 years ago by Andreas Obermair

A new study helps us to understand how women form decisions about the surgical approach to hysterectomy.

A paper recently published by Queensland Centre for Gynaecological Cancer researchers help clinicians, researchers and health policy makers to understand why many women still receive an open hysterectomy through an abdominal incision despite many learned societies recommending a less invasive (laparoscopic) procedure instead.

There are 4 common ways to remove the uterus (have a hysterectomy). The most common way is vaginal (through the vagina), open (through an abdominal incision), laparoscopic or robotic. The pros and cons for each surgical approach are listed here.

We all would agree that it’s important that a patient can make a well-informed decision on the right treatment plan for them. Approximately 30,000 women receive hysterectomies in Australia and face the decision of which surgical approach is most appropriate for them.

I was part of the research team that investigated and explored how much Australian women knew about hysterectomy. In 2015-2016 we conducted a questionnaire of women who had received a hysterectomy for both benign and malignant conditions in Australia in the previous two years. We invited 6,000 women to participate and 2,319 women completed the survey. The results have recently been published in Patient Education & Counceling.

We found 96% of women felt well-informed about hysterectomy, and 94% of women were aware that several surgical approaches to hysterectomy exist. Women felt better informed if they received information from a gynaecologist or GP than from the web, friends or magazines.

Women were more aware of the open abdominal approach (77%), than of less-invasive vaginal (67%), laparoscopic (66%), laparoscopic-assisted (56%), and robotic approaches (12%). Robotic approaches have not yet taken off in Australia, nor do I recommend them and I discuss why in this blog.

Abdominal hysterectomy wasthe least preferred surgical approach by women, with 5% of women stating it as a preference, but actually 26% received it. Unfortunately, the survey did not ask why women did not receive their surgical preference. Possible reasons are that the surgeon could not safely perform the woman’s preferred alternative; or that the surgeon only was experienced in the abdominal approach.

If a gynaecological surgeon can only offer you one approach to surgery, i.e abdominal surgery you can always ask for a second opinion. The majority of women (85%) surveyed did not seek a second doctor’s opinion.

What were the most important factors that influenced a patient to proceed with a hysterectomy? Sixty-three per cent of women reported their gynaecologist was the most influential information source. Following that, concerns about recovery time (53%) or surgical risks (36%) were the next big influences. Women who were conscious about recovery time, body image or surgical risks were far more likely to receive a less invasive (laparoscopic) hysterectomy option.

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