Institute of Management, MeS (Management and Health) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy
Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy.
BMJ Open. 2024 Jul 24;14(7):e084034. doi: 10.1136/bmjopen-2024-084034.
Pelvic organ prolapse (POP) affects 40% of women, with a 12%-19% lifetime surgical risk. Italy showed high practice variation in POP surgery, possibly impacting equity of access to healthcare services, a central goal of Beveridge-like health systems. According to the literature, unwarranted variation, influenced by physician attitudes or resource allocation, must be reduced. We aimed to identify determinants influencing women's choice when asked whether they prefer surgical or conservative POP management.
DESIGN, SETTING AND POPULATION: In this nationwide prospective study, we distributed a Qualtrics questionnaire via social media to any Italian women over 18 years old who voluntarily decided to participate in the survey.
A grade 3 POP scenario was presented. Women were asked how likely they would have surgery. Each woman randomly received only 1 question out of 11: 1 question was the reference question ('How likely would you have surgery?') while 10 questions contained a potential determinant influencing woman's choice ('How likely would you have surgery if…?').
The outcome was the chance of choosing surgery expressed as a percentage. We analysed the effect of each factor on the outcome by using adjusted beta regression models.
Respondents (n=222) opted for surgery with a median probability of 61.5%. Factors significantly increasing the chance of choosing surgery were advice from physicians, the presence of a trusted physician during hospitalisation, surgical approach with low complication rates, uterine-sparing surgery, the absence of postoperative abdominal scars and nearby hospital.
Our findings provide health managers and policy-makers with new evidence to better understand women's decision-making and partly capture the determinants of unwarranted variation. These inputs may also be used as attributes for a future discrete choice experiment.
盆腔器官脱垂（POP）影响了 40%的女性，终生手术风险为 12%-19%。意大利在 POP 手术方面存在着很高的实践差异，这可能会影响到医疗保健服务的公平性，而这是贝弗里奇式医疗体系的核心目标。根据文献，必须减少由医生态度或资源分配等因素导致的不合理差异。我们旨在确定影响女性在被问及是否愿意接受 POP 手术或保守治疗时选择的决定因素。
设计、地点和人群：在这项全国性的前瞻性研究中，我们通过社交媒体向任何自愿参加调查的 18 岁以上的意大利女性分发了一份 Qualtrics 问卷。
呈现了一个 3 级 POP 场景。女性被问及她们接受手术的可能性有多大。每位女性随机只收到 11 个问题中的 1 个：1 个问题是参考问题（“你接受手术的可能性有多大？”），而 10 个问题包含影响女性选择的潜在决定因素（“如果……你接受手术的可能性有多大？”）。
作为一个百分比表示的选择手术的机会是结果。我们通过使用调整后的贝塔回归模型来分析每个因素对结果的影响。
我们的研究结果为卫生管理人员和政策制定者提供了新的证据，以更好地了解女性的决策，并部分了解不合理差异的决定因素。这些投入也可作为未来离散选择实验的属性。
