Chapter V

Keukens, Anne
2026 · doi:10.34894/hqi7u7 · W7208730400
Observational OA: green CC0
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This multicenter study evaluated treatment counseling for deep endometriosis with bowel involvement, finding high shared decision-making levels despite considerable variation in the comprehensiveness of hormonal versus surgical information provided.

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Abstract

Objective: To evaluate both the content of treatment counseling and the extent of shared decision making (SDM) for patients with deep endometriosis (DE) and bowel involvement in specialised endometriosis centers in the Netherlands. Methods: This multicenter cross-sectional observational study included audio-recorded treatment counseling consultations from patients with DE and bowel involvement across five specialised Dutch endometriosis centers. The content of treatment counseling was evaluated using a predefined checklist with relevant treatment options and their associated benefit and risks. SDM was assessed objectively using the Observing Patient Involvement (OPTION(5)) instrument and subjectively using the Shared Decision Making Questionnaires completed by patients (SDM-Q-9) and clinicians (SDM-Q-Doc). Potential determinants of SDM were explored using regression analyses. Results: A total of 39 counseling consultations conducted by nine gynaecologists were analysed. Assessment of the counseling content revealed considerable variation in the information provided during consultations. Surgical treatment was discussed comprehensively in most consultations, whereas counseling regarding hormonal treatment was less comprehensive. Observer-, patient-, and clinician-reported SDM all indicated a high level of SDM, with a median total OPTION(5) score of 75.0 (IQR 25.0), a median SDM-Q-9 score of 84.4, and a median SDM-Q-Doc score of 75.6. Consultation duration was positively associated with OPTION(5) scores. Conclusion: Considerable variation was observed in the content of treatment counseling for patients with DE and bowel involvement in specialized Dutch endometriosis centers, particularly regarding hormonal treatment. Despite this variation, the overall level of SDM was high. Opportunities remain to improve the consistency and completeness of information provision while maintaining a high level of SDM. Practice implications: Although SDM was well embedded in clinical practice, greater attention should be paid to ensuring consistent and comprehensive treatment information. Counseling tools and/or decision aids may support clinicians and patients in discussing all relevant treatment options, benefits, and risks while maintaining individualized care.
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