Duyar Susan, Tsai Susan, Milad Magdy P, Chaudhari Angela
Department of Obstetrics and Gynecology (Dr. Duyar), Division of Gynecologic Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Obstetrics and Gynecology (Drs. Tsai, Milad, and Chaudhari), Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
J Minim Invasive Gynecol. 2023 Oct;30(10):797-804. doi: 10.1016/j.jmig.2023.05.012. Epub 2023 May 26.
To investigate the attitudes toward and beliefs about hysterectomy that influence the decision of women with symptomatic uterine fibroids regarding hysterectomy.
A prospective survey study.
An outpatient clinic.
Patients in an urban, academic complex gynecology outpatient clinic at the age of 35 years or older with uterine fibroids and without previous hysterectomy were invited to participate. A total of 67 participants were surveyed between December 2020 and February 2022.
Data were collected on demographics, Uterine Fibroid Symptom Health-Related Quality of Life (UFS-QOL) Questionnaire scores, and beliefs regarding hysterectomy via a web-based survey. Participants were posed with clinical scenarios and asked to indicate a preference for hysterectomy or myomectomy and stratified into groups by acceptability of hysterectomy as a treatment option for fibroids.
Data were analyzed using chi-square or Fisher exact tests, t tests, or Wilcoxon tests as appropriate. The mean age of participants was 46.2 (SD 7.5) years, and 57% of participants self-identified as White/Caucasian. The mean UFS-QOL symptoms score was 50 (SD 26) and the mean overall health-related quality of life score was 52 (SD 28). Notably, 34% of participants preferred hysterectomy whereas 54% preferred myomectomy assuming equivalent efficacy; 44% of those who preferred myomectomy did not desire future fertility. There were no differences observed in UFS-QOL scores. Participants opting for a hysterectomy believed that it would improve their mood/emptions, relationship with partner, general quality of life, sense of femininity, feeling whole, identity/body image, sexuality, and relationships. Those who opted for a myomectomy believed all those factors would worsen with a hysterectomy, and in addition, it would worsen their vaginal moisture and their partner's experience.
Many factors affect a patient's decisions regarding hysterectomy for uterine fibroids beyond those related to fertility, including factors related to body image, sexuality, and relationships. Physicians should consider these factors when counseling patients and recognize their importance to facilitate improved shared decision making.
调查影响有症状子宫肌瘤女性行子宫切除术决策的对子宫切除术的态度和信念。
一项前瞻性调查研究。
一家门诊诊所。
邀请年龄在35岁及以上、患有子宫肌瘤且未行过子宫切除术的城市学术综合妇科门诊患者参与。2020年12月至2022年2月期间共调查了67名参与者。
通过网络调查收集人口统计学数据、子宫肌瘤症状健康相关生活质量（UFS-QOL）问卷得分以及对子宫切除术的信念。向参与者呈现临床情景，要求他们表明对子宫切除术或肌瘤切除术的偏好，并根据子宫切除术作为肌瘤治疗选择的可接受性进行分组。
根据情况使用卡方检验或Fisher精确检验、t检验或Wilcoxon检验分析数据。参与者的平均年龄为46.2（标准差7.5）岁，57%的参与者自我认定为白人/高加索人。UFS-QOL症状平均得分为50（标准差26），总体健康相关生活质量平均得分为52（标准差28）。值得注意的是，假设疗效相同，34%的参与者倾向于子宫切除术，而54%的参与者倾向于肌瘤切除术；倾向于肌瘤切除术的参与者中有44%不期望未来生育。UFS-QOL得分未观察到差异。选择子宫切除术的参与者认为这将改善他们的情绪/情感、与伴侣的关系、总体生活质量、女性气质、完整感、身份/身体形象、性功能和人际关系。选择肌瘤切除术的参与者认为，子宫切除术会使所有这些因素恶化，此外，还会使阴道湿润度和伴侣的体验变差。
除了与生育相关的因素外，许多因素会影响患者对子宫肌瘤子宫切除术的决策，包括与身体形象、性功能和人际关系相关的因素。医生在为患者提供咨询时应考虑这些因素，并认识到它们对于促进改善共同决策的重要性。
