Patient preferences regarding the cervix, ovaries, and fallopian tubes at the time of hysterectomy: a qualitative study

Jenna C. Adams, Madelyn Conner, Jackie Wong, Andrea K. Knittel, Michelle Louie
In: Women & Health · 2024 · vol. 64(10) , pp. 783–792 · doi:10.1080/03630242.2024.2416219 · PMID:39428648 · W4403584028
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This qualitative study found that patients undergoing hysterectomy often lacked knowledge about organ removal consequences and based decisions on long-term effects and symptom relief, not immediate surgical risk.

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Abstract

= 13) ranged from 24 to 60 years. Identified themes included knowledge, decision-making, treatment goals, short- and long-term consequences, fertility, identity, and lack of concern. Many participants expressed lacking necessary knowledge of the risks and benefits of removing the cervix and adnexa. Treatment goals included symptom relief and definitive treatment. Long-term consequences included concerns about menopause and future cancer. Many patients expressed some degree of lack of knowledge, desire to remove most or all pelvic structures, or no attachment to their reproductive organs. Many patients expressed decision-making based on the effects of organ removal on long-term consequences and the relief of current symptoms, rather than immediate surgical risk. This information can help to inform patient-centered surgical counseling.
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ABSTRACT Our objective is to understand patients’ preexisting values, beliefs, and preferences regarding removal or preservation of the cervix, ovaries, and fallopian tubes at the time of hysterectomy for benign indications. We performed semi-structured interviews from August 2021 to March 2022 with patients referred for hysterectomy. Participants were recruited according to pre-specified diversity axes. The interview guide was informed by literature review, expert stakeholders, and pilot testing. pers. comm. occurred prior to scheduled consultation. Responses were analyzed for themes, with thematic saturation reached. Age of participants (n = 13) ranged from 24 to 60 years. Identified themes included knowledge, decision-making, treatment goals, short- and long-term consequences, fertility, identity, and lack of concern. Many participants expressed lacking necessary knowledge of the risks and benefits of removing the cervix and adnexa. Treatment goals included symptom relief and definitive treatment. Long-term consequences included concerns about menopause and future cancer. Many patients expressed some degree of lack of knowledge, desire to remove most or all pelvic structures, or no attachment to their reproductive organs. Many patients expressed decision-making based on the effects of organ removal on long-term consequences and the relief of current symptoms, rather than immediate surgical risk. This information can help to inform patient-centered surgical counseling. Disclosure statement Michelle Louie is a consultant for Hologic Inc. and Gynesonics and receives personal compensation. None of the other authors have a potential conflict of interest to report. Data availability statement The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to the potential for compromising the privacy of research participants. Supplementary material Supplemental data for this article can be accessed online at https://doi.org/10.1080/03630242.2024.2416219.

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