Sangha Roopina, Bossick Andrew, Su Wan-Ting K, Coleman Chad, Chavali Neha, Wegienka Ganesa
Department of Women's Health Services, Henry Ford Health System, Detroit, MI.
Department of Public Health Sciences, Henry Ford Health System, Detroit, MI.
J Patient Cent Res Rev. 2020 Oct 23;7(4):329-336. eCollection 2020 Fall.
This study sought to identify patterns of self-reported regret after hysterectomy.
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.
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).
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.
本研究旨在确定子宫切除术后自我报告的遗憾模式。
在手术前2周招募因良性指征接受子宫切除术的女性。女性报告人口统计学信息，并在术后第一年最多完成7次经过验证的问卷调查（决策遗憾量表、患者健康问卷-9、决策冲突量表和财务毒性综合评分）。查阅医疗记录以获取临床和手术细节。应用潜在类别增长混合模型对重复的遗憾分数进行分析，以确定子宫切除术后的模式。对各类别之间的临床和其他参与者特征进行比较。
在459名参与者（其中422人在12个月时完成问卷调查）中确定了三个潜在类别：“高遗憾”（7.4%），基线时遗憾分数高且随时间未改善的女性；“遗憾减少”（13.3%），基线时遗憾水平高但遗憾分数随时间改善的女性；以及“最少遗憾”（79.3%），基线遗憾分数最低且术后仍保持较低水平的女性。这些类别在手术指征、临床特征、年龄或体重指数方面没有差异。与“最少遗憾”类别相比，“遗憾减少”类别中的非裔美国女性比例过高（调整后的优势比：1.99，95%置信区间：1.01-3.9）。各类别之间的基线满意度有所不同，“最少遗憾”组对其决策的基线满意度更高。与“最少遗憾”类别中的女性相比，“遗憾减少”的女性报告手术相关的财务毒性更差（调整后的优势比：0.95，95%置信区间：0.92-0.99）。
对于一些女性来说，子宫切除术后决策遗憾可能会恶化。更多时候，最初的遗憾会随着时间的推移而减轻。确定与自我报告的遗憾密切相关的因素的未来研究可能会改善对术后期望的咨询。
