Bridging different realities - a qualitative study on patients’ experiences of preoperative care for benign hysterectomy and opportunistic salpingectomy in Sweden

Abstract

Background Hysterectomy is a common procedure worldwide and removing healthy fallopian tubes at the time of hysterectomy (opportunistic salpingectomy) to possibly prevent ovarian cancer is increasing in frequency, but still controversial. The experiences and perceptions of women, eligible for the procedure, have not been previously investigated. This study aims to, among women waiting to undergo hysterectomy, explore i) experiences and perceptions of self and healthcare in relation to their elective surgery, ii) perceptions of risks and benefits of hysterectomy, including opportunistic salpingectomy. Methods A qualitative study, with focus group discussions including women < 55 years, planned for hysterectomy with ovarian preservation, was performed. Participants were recruited through purposive sampling from six gynecological departments in different parts of Sweden, including both country and university hospitals. Focus group discussions were conducted using a semi-structured interview guide, digitally recorded, transcribed verbatim and analysed by qualitative manifest and latent content analysis. Results Twenty-one Swedish-speaking women participated. They were 40–53 years of age, reported varying educational levels, countries of birth and indications for hysterectomy. Analysis rendered a theme “Bridging different realities” over four categories: “Being a woman today”, “Experiencing and managing body failure”, “Navigating the healthcare system” and “Processing continuously until surgery”, including 17 subcategories. The participants displayed varying attitudes towards the significance of their uterus in being a woman. A vague understanding of their body was described, leading to fear related to the reasons for surgery as well as surgery itself. Participants described difficulties understanding and recalling information but also stated that insufficient information was provided. Perceptions of the risks and benefits of opportunistic salpingectomy varied. Involvement in decisions regarding the hysterectomy and potential opportunistic salpingectomy was perceived to be dependent on the counselling gynecologist. Conclusions The theme Bridging different realities captures the complexity of women deciding on removal of their uterus, and possibly fallopian tubes. It also describes the women’s interactions with healthcare and perceived difference between the health professionals and the women’s perception of the situation, as viewed by the women. Bridging the different realities faced by patients is required to enable shared decision-making, through sufficient support from healthcare.

Salpingectomy for the Primary Prevention of Ovarian Cancer

“…In 2015, Kang et al surveyed 100 healthy volunteers to assess barriers to performing salpingectomy; 71% of respondents did not realize the seriousness of ovarian cancer, 79% were unaware of the theory that the fallopian tube is the origin of epithelial ovarian cancer, and 87% had never heard of salpingectomy as a preventive method for ovarian cancer. A 2020 study by Collins et al found varying patient opinions of salpingectomy, and the decision to undergo salpingectomy at the time of hysterectomy was perceived to be dependent on the counseling gynecologist. Similar findings were demonstrated by Gelderblom et al in 2021; the main barriers to implementing salpingectomy were lack of knowledge about the existence of the procedure (45%) and concerns about the removal of healthy organs (46%).…”

Nursing educational intervention in hysterectomized women: a mixed method study protocol

“…It is important to recognize and adequately attend the needs of women during the perioperative hysterectomy period, an aspect which has been evidenced by multiple studies, which report how insufficient is the information women have and how few opportunities they have to participate in this process, being reduced to depend on the health worker (6,28) .…”

“…In the current study, we expect results from the qualitative stage to allow showing the meaning of education in the perioperative stage; questions and uncertainties regarding the surgical act and the state of health of women; as well as get closer to the experiences of women in the perioperative stages of hysterectomy and, therefore, from a professional perspective, to be able to understand this phenomenon and identify areas where an educational intervention can be carried out (28) , in order to contribute to the design and elaboration of the nursing educational intervention with the support of a webpage. Later, the quantitative results will allow us to know the effect of the educational intervention, as reported in intervention studies based on counseling, individualized recommendations for recovery based on experts, and education based on specific models, improving the variables mentioned before (12,(13)(14)(15) .…”

Physicians' assessment of complications after gynecological surgery in Sweden: The GYNCOM survey

“…However, there is a lack of common definition to differentiate functional intestinal problems from postoperative paralysis, 16 and the patient's description of the grade of discomfort might be the deciding factor if it is regarded as a complication. In a study with women waiting for gynecological surgery in Sweden the women described insufficient knowledge of what to expect in the recovery after surgery 17 and an association between presurgical expectations and quality of life after surgery has been found. 18 The preoperative information that the woman receives most likely affects what symptoms she accepts to be a part of normal recovery and how she experiences them.…”