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Gynecologic Surgical Outcomes Through the Patient’s Eyes

Are Physicians Looking in the Same Direction?

Emerson, Jenna, MD*; Paquet, Amanda, MD; Sangha, Roopina, MD, MPH‡§¶; Robison, Katina, MD∥**††‡‡

Obstetrical & Gynecological Survey: June 2019 - Volume 74 - Issue 6 - p 351–361
doi: 10.1097/OGX.0000000000000681
CME ARTICLES
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CME

Importance Patient-centered care integrates the highest clinical standards with patient preferences surrounding their treatment. Increasing focus is being placed on the identification of patient-centered outcomes to optimize the impact of medical treatments on patient quality of life, as defined by patients themselves.

Objective This article will review the central concepts of patient-centered outcomes in benign gynecologic surgery. This expert review will serve as a practical guide for surgeons to incorporate patient preferences into shared surgical decision making.

Evidence Acquisition The current literature is examined, defining those outcomes identified by women undergoing gynecologic procedures as the most important factors in their decision making. Available literature on these patient-identified priorities is then reviewed with respect to gynecologic surgery in the preoperative, intraoperative, and postoperative periods.

Results Each section of the article concludes with Clinical Pearls, where practical tools and key elements are summarized to assist providers with incorporating these concepts into practice.

Conclusions and Relevance Many key outcomes have been identified by women undergoing benign gynecologic surgery in their decision-making process. Patient counseling should address clinically appropriate treatment modalities and include an exploration of patient expectations and preferences around nonclinical outcomes as well. This shared decision-making model will result in improved satisfaction with outcomes.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the learner should be better able to support patient-centered informed decision making regarding gynecological procedures; describe the benefits of an Enhanced Recovery After Surgery protocol and the importance of preoperative pain burden; counsel patients regarding the impact of hysterectomy on sexual function; and explain incision types and their influence on cosmesis with patients.

*Fellow of Gynecology Oncology at Women & Infants Hospital of Rhode Island/Warren Alpert Medical School of Brown University, Providence, RI;

Chief Resident, and

Program Director, Obstetrics and Gynecology Residency Program, Henry Ford Hospital/Wayne State University;

§Vice Chair, Graduate Medical Education Committee, Faculty Minimally Invasive and Robotic Surgery Fellowship;

Associate Professor (FTA), Wayne State University, School of Medicine, Detroit, MI;

Gynecologic Oncologist and Associate Professor of Obstetrics and Gynecology at The Warren Alpert Medical School of Brown University;

**Director of Research for the Program in Women's Oncology;

††Director of the Women's Intimacy and Sexual Health (WISH) Clinic; and

‡‡Codirector of the Colposcopy Clinic at Women & Infants Hospital, Providence, RI

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.

Correspondence requests to: Roopina Sangha, MD, MPH, Department of Obstetrics and Gynecology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202. E-mail: rsangha1@hfhs.org.

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