Myomectomy: Factors Influencing Patient Decision-Making and Satisfaction [10D]


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Abstract

INTRODUCTION:Myomectomy is a uterine-sparing treatment in women with symptomatic leiomyoma. We explored the decision-making process and overall postoperative satisfaction in patients who chose to undergo myomectomy.METHODS:Sequential mixed method design: retrospective chart review (n=1,380) of patients undergoing myomectomy at suburban hospital from 2011-2013, and postoperative mail survey of same population. Myomectomy routes: abdominal, laparoscopically-assisted abdominal (LAAM), conventional laparoscopic (CLM) & robotic-assisted (RAM). Myomectomy route was verified via corresponding survey identifiers. Survey response rate = 7.2%. Survey questions addressed preoperative education, patient decision-making process, complications, and patient satisfaction.RESULTS:Of 79 respondents: 18% abdominal, 48% LAAM, 16% CLM and 18% RAM. The top three reasons indicated for having a myomectomy was heavy periods (41.5%), fertility (26.8%) and painful periods (19.5%). 78.5% indicated the route of myomectomy mattered to them, yet 71.2% did not seek a second opinion. Primary reason for not seeking a second opinion was trust in their OBGYN (76.4%). 98% of respondents indicated they were satisfied with the “surgeon’s explanation of the surgical procedure,” yet 57.7% did not correctly identify their type of myomectomy. There was no significant difference in patient satisfaction with overall results of surgery across all myomectomy types. Postoperative care/follow-up was the only significant predictor of patient satisfaction (P <.05).CONCLUSION:Trust in the physician was the most significant factor in the patient decision-making process to undergo surgery, while postoperative follow-up care was most significant to overall patient satisfaction. This survey highlights the need for the OBGYN to recommend the most appropriate treatment option to their patients.

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