Journal of Behavioral Medicine

, Volume 21, Issue 3, pp 283–297

Patients' Expectations of Outcome of Hysterectomy and Alternative Treatments for Menstrual Problems

  • Susan Marchant-Haycox
  • David Liu
  • Nick Nicholas
  • Peter Salmon
Article

Abstract

Patients can influence treatment to the extent of securing surgery in the absence of medical need, but their expectations of effects of surgery are poorly understood. Interviews with 26 patients presenting menstrual problems without confirmed pathology were used to construct a questionnaire to measure expectations of effects of treatment. Principal-components analysis of responses of 200 similar patients identified six discrete areas in which improvement was expected, including general well-being, menstrual function, and physical symptoms. Expectations of harm were nonspecific and unidimensional. Component-based scale scores showed that patients who anticipated hysterectomy expected more benefit, but also more harm, than those anticipating conservative procedures. In study 2, these different expectations were largely replicated in patients who were randomly allocated to provide their expectations of specific procedures. Patients' uniquely positive expectations of hysterectomy may help to explain its frequent use in the absence of pathology.

EXPECTATIONS HYSTERECTOMY GYNECOLOGY 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Armstrong, D., Fry, J., and Armstrong, P. (1991). Doctors' perceptions of pressure from patients for referral. Br. Med. J. 302: 1186–1188.Google Scholar
  2. Bachman, G. A. (1990). Hysterectomy: A critical review. J. Reprod. Med. 3: 839–862.Google Scholar
  3. Bernhard, L. (1986). Methodology issues in studies of sexuality and hysterectomy. J. Sex Res. 22: 108–128.Google Scholar
  4. Bernhard, L. A. (1985). Black women's concerns about sexuality and hysterectomy. Sage 2: 25–27.Google Scholar
  5. Brody, D. S., Miller, S. M., Lerman, C. E., Smith, D. G., Lazaro, C. G., and Blum, M. J. (1989). The relationship between patients' satisfaction with their physicians and perceptions about interventions they desired and received. Med. Care 27: 1027–1035.Google Scholar
  6. Carlson, K. J., Miller, B. A., and Fowler, F. J. (1994). The Maine women's health study: I. Outcomes of hysterectomy. Obstet. Gynecol. 83: 556–565.Google Scholar
  7. Coulter, A., and McPherson, K. (1986). The hysterectomy debate. Q. J. Soc. Affairs 2: 379–396.Google Scholar
  8. Dwyer, N., Hutton, J., and Stirrat, G. M. (1993). Randomized controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia. Br. J. Obstet. Gynaecol. 100: 237–243.Google Scholar
  9. Gath, D., Cooper, P., and Day, A. (1982). Hysterectomy and psychiatric disorder, 1. Levels of psychiatric morbidity before and after hysterectomy. Br. J. Psychiat. 40: 335–342.Google Scholar
  10. Kiyak, H. A. (1988). Patients' expectations as predictors of orthognathic surgery outcomes. Health Psychol. 7: 251–268.Google Scholar
  11. Kravitz, R. L., Cope, D.W., Leake, B., and Bhrany, V. (1994). Internal-medicine patients' expectations for care during office visits. J. Gen. Intern. Med. 9: 75–81.Google Scholar
  12. MacKenzie, I. Z., and Bibby, J. G. (1978). Critical assessment of dilatation and curettage in 1029 women. Lancet 2: 566–569.Google Scholar
  13. Marchant-Haycox, S., and Salmon, P. (1997). Patients' and doctors' strategies in consultations with unexplained symptoms: Interactions of gynecologists with women presenting menstrual problems. Psychosomatics 38: 440–450.Google Scholar
  14. Martin, R. L., Roberts, W. V., and Clayton, P. J. (1980). Psychiatric status after hysterectomy. JAMA 244: 350–353.Google Scholar
  15. Pyper, R. J. D., and Haeri, A. D. (1991). A review of 80 endometrial resections for menorrhagia. Br. J. Obstet. Gynaecol. 98: 1049–1054.Google Scholar
  16. Ryan, M. M., Dennerstein, L., and Pepperell, R. (1989). Psychological aspects of hysterectomy: A prospective study. Br. J. Psychiat. 154: 516–522.Google Scholar
  17. Salmon, P., and May, C. (1995). Patients' influence on doctors' behavior: A case study of patient strategies in somatization. Int. J. Psychiat. Med. 25: 309–319.Google Scholar
  18. Salmon, P., Sharma, N., Valori, R., and Bellenger, N. (1994). Patients' intentions in primary care: relationship to physical and psychological symptoms and their perception by general practitioners. Soc. Sci. Med. 38: 585–592.Google Scholar
  19. Sandberg, S. I., Barnes, B.A., Weinstein, M. C., and Braun, P. (1983). Elective hysterectomy: Benefits risks and costs. Med. Care 23: 1067–1085.Google Scholar
  20. Schulze, C., Florin, I., Matschin, E., Sougioultzi, C., and Schulze, H. H. (1988). Psychological distress after hysterectomy—A predictive study. Psychol. Health 2: 1–12.Google Scholar
  21. Shorter, E. (1992). From Paralysis to Fatigue: A History of Psychosomatic Illness, Free Press, New York.Google Scholar
  22. Singh, B., Raphael, B., Gyanshwar, R., and Johnston, P. (1983). A review and report of two follow-up studies. Austr. N.Z. J. Psychiat. 17: 227–235.Google Scholar
  23. Teo, P. Y. K. (1990). Hysterectomy: A change of trend or a change of heart. In Roberts, H. (ed.), Women's Health Counts, Routledge, London, pp. 113–146.Google Scholar
  24. Travis, C. B. (1985). Medical decision making and elective surgery: The case of hysterectomy. Risk Anal. 5: 241–251.Google Scholar
  25. Tsoi, M. M., Poon, R. S. M., and Ho, C. (1983). Knowledge about reproductive organs in Chinese women: Some overlooked “commonsense. ” J. Psychosom. Obstet. Gynaecol. 2: 70–75.Google Scholar
  26. Tsoi, M. M., No, P. C., and Poon, S. M. (1984). Pre-operation indicators and post-hysterectomy outcome. Br. J. Clin. Psychol. 23: 151–152.Google Scholar
  27. Virji, A., and Britten, N. (1991). A study of the relationship between patients' attitudes and doctors' prescribing. Fam. Pract. 8: 314–319.Google Scholar
  28. Walmsley, P. N. H., Brockopp, D. Y., and Brockopp, G. W. (1992). The role of prior pain experience and expectations on postoperative pain. J. Pain Symptom Manage. 7: 34–37.Google Scholar
  29. Wallace, L. M. (1985). Psychological adjustment to and recovery from laparoscopic sterilization and infertility investigation. J. Psychosom. Res. 29: 507–518.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Susan Marchant-Haycox
    • 1
  • David Liu
    • 2
  • Nick Nicholas
    • 3
  • Peter Salmon
    • 4
  1. 1.Department of PsychologyUniversity College LondonLondonUK
  2. 2.Department of Obstetrics and GynaecologyQueen's Medical Centre, University of NottinghamNottinghamUK
  3. 3.Department of Obstetrics and GynaecologyHillingdon HospitalUxbridgeUK
  4. 4.Department of Clinical PsychologyUniversity of LiverpoolUK

Personalised recommendations