Web-Based Decision Aid for Women Considering Elective Hysterectomy

Grant Application

Suketu Mansuria, MD, Magee-Womens Hospital of UPMC,, and Faina Linkov, PhD, MPH, University of Pittsburgh

Proposed Innovation

Each year, approximately 600,000 women undergo a hysterectomy — one of the most common gynecologic procedures performed in the United States. The vast majority are elective procedures used to treat conditions such as heavy vaginal bleeding, fibroids, and pelvic pain. Recent data indicates that the use of open (abdominal) surgery for hysterectomy has become excessive despite the emergence of minimally invasive hysterectomy techniques. Due to lack of patient education and awareness, many women agree to have an open abdominal hysterectomy without considering other options.

Reducing the use of open hysterectomy — and encouraging minimally invasive procedures such as vaginal and laparoscopic hysterectomies — has many benefits, including decreased health care costs, reduced infection rates, fewer complications, and faster return to normal activities. Through this project, an online educational tool was developed for use as a decision aid to educate patients about their condition, treatment and surgical options, pros and cons of each option, and the complication and success rates for each option. The goal is to encourage women to be active partners in selecting an approach for hysterectomy that works best for them.

Improvements

The team worked with health care providers to develop patient and provider educational aids to help women considering elective hysterectomy for benign conditions, including heavy bleeding, endometriosis, and fibroids. During pilot testing, 20 patients used the decision aid and filled out surveys about their utility. Patients found it to be very practical and helpful in their decision-making process.

As part of this project, a hysterectomy surgery comparison chart was developed and posted on the website to help women with their decision making. Paper handouts also are provided to women without Internet access.

Outcomes

The online decision support and educational tool helps patients make more informed decisions regarding hysterectomies, including increased use of less invasive procedures.

The website content has been shared with all health care providers serving patients who may need a hysterectomy. It also has been promoted in the UPMC and Magee-Womens Hospital of UPMC newsletters and nationally through emails, conferences, and health-related newsletters.

The decision aid will be developed in six major steps: information gathering, planning, design, development, testing, and delivery. The project will conclude with pilot testing of the website and decision support aids by a group of patients considering hysterectomy.

The website content will be shared with all health care providers serving patients who may need a hysterectomy. It also will be promoted in the UPMC and Magee-Womens Hospital of UPMC newsletters and nationally through emails, conferences, and health-related newsletters. UPMC physicians will be encouraged to share information with their patients. The site will be monitored and updated on a quarterly basis.