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Which surgical decisions should patients participate in and how? Reflections on women's recollections of discussions about variants of hysterectomy

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  • Entwistle, Vikki
  • Williams, Brian
  • Skea, Zoe
  • MacLennan, Graeme
  • Bhattacharya, Siladitya

Abstract

Current guidance about informed consent suggests patients ought to know about the procedures involved in any treatments they agree to undergo, and have a right to be involved in decisions about their care. However, it is not clear how this guidance is and should be applied to decisions between variant surgical procedures such as abdominal or vaginal hysterectomy. We sent structured questionnaires about information provision and decision-making to 157 women who were scheduled for hysterectomy in north-east Scotland. A purposive sub-sample of 20 women was interviewed in depth post-operatively. 104 women (66%) responded to the questionnaires. 75% reported being told at outpatient clinics what kind of hysterectomy they would have, but fewer than half had been told about the advantages and disadvantages of different kinds. Between 26% and 65% of women thought they had been given too little information about various issues pertaining to different types of hysterectomy. The interview accounts suggested that gynaecologists offered women little opportunity to influence the selection of a surgical procedure. Women did not express a desire for a greater say in this selection, but appreciated being told, or would have liked to know, why particular procedures were recommended for them. There may be circumstances in which it is important for surgeons to tell patients about options they have ruled out in their particular cases. Decisions between alternative surgical procedures are often highly contingent on the dispositions and skills of individual surgeons. They raise practical and ethical issues that have been neglected in recent discussions about patient involvement in decision-making. As policy makers continue to emphasise the importance of choice and patients become increasingly aware of the existence of variant procedures, these issues need careful consideration.

Suggested Citation

  • Entwistle, Vikki & Williams, Brian & Skea, Zoe & MacLennan, Graeme & Bhattacharya, Siladitya, 2006. "Which surgical decisions should patients participate in and how? Reflections on women's recollections of discussions about variants of hysterectomy," Social Science & Medicine, Elsevier, vol. 62(2), pages 499-509, January.
  • Handle: RePEc:eee:socmed:v:62:y:2006:i:2:p:499-509
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    References listed on IDEAS

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    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
    3. Guadagnoli, Edward & Ward, Patricia, 1998. "Patient participation in decision-making," Social Science & Medicine, Elsevier, vol. 47(3), pages 329-339, August.
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    1. Liv‐Helen Heggland & Kjell Hausken, 2014. "Patient participation, decision‐makers and information flow in surgical treatment," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(9-10), pages 1430-1444, May.
    2. Entwistle, Vikki & Prior, Maria & Skea, Zoe C. & Francis, Jillian J., 2008. "Involvement in treatment decision-making: Its meaning to people with diabetes and implications for conceptualisation," Social Science & Medicine, Elsevier, vol. 66(2), pages 362-375, January.
    3. Liv-Helen Heggland & Kjell Hausken, 2013. "A Qualitative Identification of Categories of Patient Participation in Decision-Making by Health Care Professionals and Patients During Surgical Treatment," Clinical Nursing Research, , vol. 22(2), pages 206-227, May.
    4. shuster, stef m., 2019. "Performing informed consent in transgender medicine," Social Science & Medicine, Elsevier, vol. 226(C), pages 190-197.
    5. Bugge, Carol & Entwistle, Vikki A. & Watt, Ian S., 2006. "The significance for decision-making of information that is not exchanged by patients and health professionals during consultations," Social Science & Medicine, Elsevier, vol. 63(8), pages 2065-2078, October.
    6. Mendick, Nicola & Young, Bridget & Holcombe, Christopher & Salmon, Peter, 2010. "The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives," Social Science & Medicine, Elsevier, vol. 70(12), pages 1904-1911, June.

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