A Prospective Study of Patterns of Regret in the Year After Hysterectomy

Sangha R, Roopina Sangha, Andrew S. Bossick, Andrew Bossick, Wan-Ting K Su, Su WK, Chad Coleman, Coleman C, Neha Chavali, Chavali N, Ganesa Wegienka, Wegienka G
Journal of patient-centered research and reviews · 2020 · vol. 7(4) , pp. 329–336 · doi:10.17294/2330-0698.1759 · PMID:33163553 · PMC7644126
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This prospective study of 459 women undergoing hysterectomy identified three distinct patterns of postoperative regret, noting that African American women were more likely to experience decreasing regret and reporting higher financial toxicity than those with consistently low regret.

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This prospective study examined self-reported regret among 459 women undergoing hysterectomy for benign indications, utilizing validated questionnaires administered up to seven times during the first year post-surgery. Latent class growth mixture models identified three distinct trajectories: a small group with persistent high regret, a moderate group whose initial regret decreased over time, and the majority who experienced consistently low regret from baseline. The researchers found that regret patterns were not associated with surgical indication or clinical characteristics, but African American women were more likely to fall into the decreasing regret category, while financial toxicity correlated with higher initial regret levels. Relevance to endometriosis: listed as one indication for hysterectomy, though the paper's main focus is general patient satisfaction and regret following surgery for various benign conditions.

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Abstract

PURPOSE: This study sought to identify patterns of self-reported regret after hysterectomy. METHODS: Women undergoing hysterectomy for a benign indication were recruited in the 2 weeks prior to surgery. Women reported demographics and completed validated questionnaires (Decisional Regret Scale, Patient Health Questionnaire-9, Decisional Conflict Scale, and the Comprehensive Score for Financial Toxicity) up to 7 times over the first year postsurgery. Medical records were reviewed for clinical and operative details. Latent class growth mixture models were applied to the repeated regret scores to identify patterns after hysterectomy. Clinical and other participant characteristics were compared across the classes. RESULTS: Three latent classes were identified among the 459 participants (422 of whom completed questionnaires at 12 months): "High Regret" (7.4%), women with a high regret score at baseline that did not improve over time; "Decreasing Regret" (13.3%), women with high baseline levels of regret but whose regret scores improved over time; and "Least Regret" (79.3%), women with the lowest baseline regret scores that remained low after surgery. These classes did not vary with respect to indication for surgery, clinical characteristics, age, or body mass index. Disproportionately more African American women (adjusted odds ratio: 1.99, 95% CI: 1.01-3.9) were in the "Decreasing Regret" versus "Least Regret" classes. Baseline satisfaction varied between the classes, with the "Least Regret" group having higher baseline satisfaction with their decision. Women with "Decreasing Regret" reported worse financial toxicity associated with surgery versus women in the "Least Regret" class (adjusted odds ratio: 0.95, 95% CI: 0.92-0.99). CONCLUSIONS: For some women, decisional regret may worsen after hysterectomy. More often, initial regret lessens over time. Future studies that identify factors strongly associated with self-reported regret could lead to improved counseling about postsurgical expectations.
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Keywords

hysterectomy, regret, surgical counseling, patient expectations, financial toxicity

Abstract

Purpose: This study sought to identify patterns of self-reported regret after hysterectomy.

Methods

Women undergoing hysterectomy for a benign indication were recruited in the 2 weeks prior to surgery. Women reported demographics and completed validated questionnaires (Decisional Regret Scale, Patient Health Questionnaire-9, Decisional Conflict Scale, and the Comprehensive Score for Financial Toxicity) up to 7 times over the first year postsurgery. Medical records were reviewed for clinical and operative details. Latent class growth mixture models were applied to the repeated regret scores to identify patterns after hysterectomy. Clinical and other participant characteristics were compared across the classes.

Results

Three latent classes were identified among the 459 participants (422 of whom completed questionnaires at 12 months): “High Regret” (7.4%), women with a high regret score at baseline that did not improve over time; “Decreasing Regret” (13.3%), women with high baseline levels of regret but whose regret scores improved over time; and “Least Regret” (79.3%), women with the lowest baseline regret scores that remained low after surgery. These classes did not vary with respect to indication for surgery, clinical characteristics, age, or body mass index. Disproportionately more African American women (adjusted odds ratio: 1.99, 95% CI: 1.01–3.9) were in the “Decreasing Regret” versus “Least Regret” classes. Baseline satisfaction varied between the classes, with the “Least Regret” group having higher baseline satisfaction with their decision. Women with “Decreasing Regret” reported worse financial toxicity associated with surgery versus women in the “Least Regret” class (adjusted odds ratio: 0.95, 95% CI: 0.92–0.99).

Conclusions

For some women, decisional regret may worsen after hysterectomy. More often, initial regret lessens over time. Future studies that identify factors strongly associated with self-reported regret could lead to improved counseling about postsurgical expectations. Recommended Citation Sangha R, Bossick A, Su WTK, Coleman C, Chavali N, Wegienka G. A prospective study of patterns of regret in the year after hysterectomy. J Patient Cent Res Rev. 2020;7:329-36. doi: 10.17294/2330-0698.1759 Supplemental Figure S1 Included in Health Services Research Commons, Obstetrics and Gynecology Commons, Public Health Education and Promotion Commons, Surgery Commons, Women's Health Commons Submitted March 19th, 2020 Accepted June 9th, 2020

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