A survey of gynecologists' attitudes regarding decision making in the management of non-cancerous conditions that frequently result in hysterectomy

Objective. To explore attitudes of practicing gynecologists regarding making treatment decisions for patients with benign uterine conditions frequently treated with hysterectomy. Design. Mailed survey. Participants. 66 gynecologists practicing in the Greater Rochester, New York, area Interventions. After reading brief vignettes, respondents indicated how they would treat patients with chronic pelvic pain, uterine leiomyomas, and abnormal uterine bleeding, and rated the importance of 24 considerations in making their treatment decisions on a 1-to-5 scale ranging from not important to extremely important. Results. Fourteen considerations (58%) had group mean importance ratings higher than 3. Exploratory factor analysis identified four factors that accounted for 96% of the variance. Respondent gender, practice type, graduation from a U.S. vs a non-U.S. medical school, and opinion regarding roles of doctor and patient in making treatment decisions were associated with significant differences in factor scores. Conclusions. Gynecologists' attitudes toward hysterectomy decisions are complex, multifactorial, and variable. Depending on the extent to which these attitudes affect treatment decisions, differences among gynecologists in their clinical decision making processes could account for a substantial amount of the regional variability in hysterectomy use.