Hirsing Nina, Nestoriuc Yvonne, Buchweitz Olaf, Meyrose Ann-Katrin
Clinical Psychology and Psychotherapy, Helmut-Schmidt-University, University of the Federal Armed Forces Hamburg, Hamburg, Germany.
Institute of Systems Neuroscience, University Medical Centre, Hamburg-Eppendorf, Germany.
BMC Womens Health. 2025 Apr 28;25(1):209. doi: 10.1186/s12905-025-03686-3.
Expectations determine treatment outcomes in several medical conditions. The significance of expectations for treatment outcomes in patients with endometriosis remains unknown. Endometriosis is a painful and debilitating disease that negatively affects quality of life. Up to 30% of surgically treated patients report persistent post-operative complaints and pain disability without sufficient medical explanation, indicating the impact of non-medical factors on treatment outcomes.
The present qualitative study aimed to describe and understand pre-operative patient expectations, facilitators of and barriers to positive treatment outcomes.
As part of a large mixed-method cohort study, a subsample of N = 33 patients with endometriosis were interviewed before laparoscopy. Structured content analysis was performed.
Positive expectations included significant improvement or absence of complaints, receiving a diagnosis, and subsequently improved health-related quality of life. However, patients also reported negative expectations such as invalidation of their experience, persistence of complaints, or post-operative side effects. Patients perceived positive expectations as facilitators for positive treatment outcomes. Further facilitators included enhanced patient and treatment information, gynaecologists specialized in endometriosis, and greater awareness of endometriosis. Perceived barriers to good post-operative quality of life included post-operative pain and scarring, insufficient rest, avoidance behaviour, and stress.
Positive and negative expectations coexisted. Positive expectations suggest that participants place much hope in laparoscopy. However, these positive expectations may exceed probable treatment outcomes for some patients. Negative expectations were also expressed and constituted a risk for nocebo effects. Further identified facilitators and barriers show that patients are very clear about what is helpful or not for their health-related quality of life after laparoscopy. Patient and treatment information may be enhanced to prevent unrealistic treatment expectations and nocebo effects.
在多种医疗状况下，期望会决定治疗结果。对于子宫内膜异位症患者治疗结果的期望的重要性仍不明确。子宫内膜异位症是一种会带来疼痛且使人衰弱的疾病，会对生活质量产生负面影响。高达30%接受手术治疗的患者报告术后持续存在不适和疼痛残疾，却没有充分的医学解释，这表明非医学因素对治疗结果有影响。
本定性研究旨在描述和理解术前患者的期望、积极治疗结果的促进因素和障碍。
作为一项大型混合方法队列研究的一部分，对33例子宫内膜异位症患者的子样本在腹腔镜检查前进行了访谈。进行了结构化内容分析。
积极的期望包括症状显著改善或消失、得到诊断以及随后健康相关生活质量得到改善。然而，患者也报告了消极的期望，如自身经历不被认可、症状持续存在或术后出现副作用。患者将积极的期望视为积极治疗结果的促进因素。其他促进因素包括患者和治疗信息的增加、专门治疗子宫内膜异位症的妇科医生以及对子宫内膜异位症更高的认知度。术后生活质量良好的感知障碍包括术后疼痛和瘢痕形成、休息不足、回避行为和压力。
积极和消极期望并存。积极期望表明参与者对腹腔镜检查寄予厚望。然而，对于一些患者来说，这些积极期望可能超过了可能的治疗结果。也表达了消极期望，这构成了产生反安慰剂效应的风险。进一步确定的促进因素和障碍表明，患者非常清楚腹腔镜检查后哪些对其健康相关生活质量有帮助或没有帮助。可以增加患者和治疗信息，以防止不切实际的治疗期望和反安慰剂效应。
