Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Sociology, Faculty of Arts, University of Calgary, Calgary, AB, Canada.
Womens Health (Lond). 2023 Jan-Dec;19:17455057231181015. doi: 10.1177/17455057231181015.
Given the prevalence of women seeking surgical treatment for pelvic organ prolapse (POP), there is a need to understand women's decision-making regarding uterine-preserving versus hysterectomy-based surgeries. Historically, hysterectomy-based surgeries have been the preferred treatment for pelvic organ prolapse; however, contemporary evidence supports uterine-preserving surgeries as equivalent. At present, the lack of information available to the general public and limited options presented at surgical consultation for pelvic organ prolapse may hinder women's autonomy as they navigate surgical treatment.
To examine the factors affecting women's decision-making processes regarding uterine-preserving or hysterectomy-based surgery for pelvic organ prolapse.
This is a qualitative study.
We conducted semi-structured, qualitative interviews with women seeking surgery for pelvic organ prolapse to explore the factors affecting women's decision-making between hysterectomy-based and uterine-preserving surgeries.
Women (n = 26) used clinical and personal factors to determine which surgery was best. Women noted that the lack of evidence (clinical and/or anecdotal) available to them hindered their decision-making, causing them to rely more on their own interpretations of the evidence, what they perceived to be "normal," and what their surgeon recommended. Even with standardized discussion regarding the existing clinical equipoise between surgeries at the clinical consultation, some women still had misperceptions that hysterectomy-based surgery would convey the lowest risk of prolapse recurrence and be best for severe prolapse.
There is a need for more transparency in discussions about prolapse and the factors affecting women's decision-making for surgical repair of pelvic organ prolapse. Clinicians should be prepared to offer the option of hysterectomy-based or uterine-preserving surgeries and to clearly explain the clinical equipoise between these procedures.
鉴于寻求手术治疗盆腔器官脱垂（POP）的女性数量众多，因此需要了解女性在保留子宫与子宫切除手术之间的决策。历史上，子宫切除手术一直是治疗盆腔器官脱垂的首选方法；然而，当代证据支持保留子宫的手术同样有效。目前，由于公众缺乏相关信息，以及在盆腔器官脱垂手术咨询时提供的选择有限，这可能会限制女性的自主权，使她们在选择手术治疗时受到阻碍。
探讨影响女性在盆腔器官脱垂保留子宫与子宫切除手术之间决策的因素。
这是一项定性研究。
我们对寻求盆腔器官脱垂手术的女性进行了半结构式、定性访谈，以探讨影响她们在子宫切除与保留子宫手术之间决策的因素。
女性（n=26）使用临床和个人因素来确定哪种手术最适合。女性指出，由于缺乏可供她们参考的证据（临床和/或传闻证据），这阻碍了她们的决策，导致她们更多地依赖自己对证据的解读、她们认为的“正常”情况以及她们的医生的建议。即使在临床咨询中就手术之间现有的临床均衡进行了标准化讨论，一些女性仍然存在误解，认为子宫切除手术会降低脱垂复发的风险，并且对于严重的脱垂最为有效。
需要在讨论脱垂问题和影响女性选择手术修复盆腔器官脱垂的决策因素方面提高透明度。临床医生应该准备提供子宫切除或保留子宫手术的选择，并清楚地解释这些手术之间的临床均衡。
