Mississippi’s Women Undergoing Hysterectomies in Absence of Comprehensive Informed Consent Law

Problem Statement

Twelve out of 10,000 women who undergo a hysterectomy die of complications arising from the procedure. Due to the high mortality associated with this procedure, women should only undergo hysterectomies in life-threatening cases like uncontrollable bleeding, complications arising from childbirth, and severe infections. Approximately 90% of hysterectomy cases recorded in the U.S. annually is the result of localized illnesses (Fredericks, 2013). Localized illnesses are the infections or conditions that do not spread to other body parts such as the uterus, which may result in surgical removal of the uterus and subsequent sterilization (Jianjun, Yan, Xiujing&Biru, 2013; Sparić, Hudelist, Berisava, Gudović & Buzadzić, 2011). In some cases, women could undergo alternative, less invasive treatments that do not result in infertility (Reis, Engin, Ingec, & Bag, n.d.).

Some states have instituted laws aimed at educating women about the potential risks of undergoing hysterectomies. Texas, New York and California have documented informed consent laws that seek to protect millions of women who are potential candidates of the surgery (Preutthipan & Herabutya, 2010). This study will explore the lived experiences of women who have undergone hysterectomies in Mississippi, a state without an instituted comprehensive informed consent law. The comprehensive informed consent law aims to provide women with an opportunity to understand the alternatives that are available for hysterectomy. Ogdon (2014) purported that the patient and surgeon should have shared decision making which includes an understanding of the procedure, alternatives, potential risks and complications. A comprehensive informed consent law is a method in ensuring appropriate and adequate patient knowledge with regard to hysterectomy during the decision-making process.

Significance

This study is significant because it focuses specifically on the decision-making process of women in Mississippi who have undergone hysterectomies in the absence of a comprehensive informed consent law. By focusing on the lived experiences of this population, this study will bring insights into the perceptions of participants’ abilities to make patient-centered decisions related to their health outcomes. As such, the study’s findings have the potential to bring about positive social change in women.

Data from this study may inform legislatures regarding the need for a comprehensive informed consent law that provides clear guidelines for both patients and physicians. Because some patients do not understand surgical procedures and associated risks, informed consent is fundamental in healthcare. It signifies the physician is speaking to a patient in simple terms that the patient understands, as well as disclosing all pertinent information and dangers. As a result, the patient understands that surgery is a choice. Standards of care are established in guidelines and in the medical evidence and patients have a right to know all reasonable alternatives consistent with high-quality medicine.

Background

Article selections relating to hysterectomies and informed consent law are described here:

1. Jianjun et al. (2013) examined the evolving trend, degree and impact elements of women’s psychological standing pre- and post-hysterectomy. The findings of the study were important because they gave important information about psychological events in women before and they underwent hysterectomy.
2. Rott (2012) encouraged women to undergo hysterectomies only as a last resort. The authors of the two studies focused on understanding the negative impact of hysterectomy on women. Thus, they recommended that women could undergo hysterectomy after all other options are unsuccessful.
3. Müller et al. (2010) and Papadopoulos et al. (2010) addressed potential questions in my possible topic – specifically, when or why is it necessary to extract the entire female reproductive system?
4. Gómez-Durán and colleagues (2013) investigated the abuse of surgical operations, as well as outlined similarities between surgery practice rules and informed consent. The study author concluded that some medical personnel did not give female patients a chance to choose the best treatment option with regard to problems of the uterus. Thus, they conducted hysterectomy that resulted in permanent female infertility.
5. Reis et al. (n.d.) examined beliefs and attitudes of female patients who underwent hysterectomy in Turkey. The author concluded that beliefs and attitudes of women who underwent hysterectomy greatly determined the quality of health that characterized the women.
6. Wu, Lee, Yeh and Che (2014) discussed women’s right to choose. Wu and colleagues (2014), additionally, described informed consent as it relates to hysterectomies and uterine fibroid removal. Finally, the authors recommended mandatory legislature to make sure certain informed consent is attained prior to a woman electing to endure a hysterectomy. The author understood the important role that such legislation could play in protecting women from hysterectomies that could result in infertility.

Framework of the study

The theoretical framework of the proposed study will be based on the health belief model (HBM). This model was originally developed to explain why patients fail to participate in preventive care and treatment (Rosenstock, 1974). This model is widely utilized to give explanations and predictions with regard to health-related attributes, such as behaviors (Carpenter, 2010). This model was originally developed to explain why patients fail to participate in preventive care and treatment. The HBM is one of several behavioral theories that have been used to help explain individual health-related behavior based on several principles. The principles of this model are the “individual’s overall perception of his or her susceptibility to disease, perception of the severity of the disease and perception of the benefits from the barriers to modifying behavior” (Bellamy, 2004, p. 360). The HBM purports that an individual makes decisions regarding health behaviors (surgeries, preventive care, and follow up treatment) based on perceptions. Adequate patient education aids in making an informed choice regarding health behaviors and is an important part of how the behavior is perceived (Bellamy, 2004). The HBM will help address the lived experiences of women who have undergone hysterectomies in Mississippi by exploring how the absence of the comprehensive informed consent law affected the participants’ decisions to undergo the surgery. The HBM is useful in answering the research questions and uncovering themes related to the common phenomenon experienced by the subjects.

The theory states that patients’ behaviors are greatly used to influence their healthcare outcomes (Carpenter, 2010; Vogel, 2011). The behaviors are mostly the beliefs that patients associate with certain healthcare approaches. For example, people would assume that certain medications would not have any benefit to them. Such persons would not be healed through taking the medications because they believe that they would be ineffective in their bodies. Based on the proposed study, the model would be used to make the assumptions that women make decisions on the premises of the perceptions of the environment. For example, it would assume that those who do not seek clarification regarding hysterectomy have low education levels. Thus, even if they were told about the benefits and disadvantages, they would not benefit. The psychological model would adopt three key assumptions. First, it will hypothesize that women will take an appropriate action when they realize that hysterectomy could have a negative effect. The action could be seeking an alternative treatment approach. Second, it will assume that women would have positive expectations on the premises of taking a suggested action that would be aimed at avoiding negative impacts. Third, the theoretical framework would assume that women will successfully adopt the suggested health action in order to achieve improved health outcomes. The three assumptions would be adopted in the study to ensure that women make informed choices with regard to hysterectomy. In summary, the utilization of the model would help women to achieve better care and improved health status.

Research questions

1. What are the perceptions of women who have undergone hysterectomies without prior awareness of comprehensive informed consent law?
2. What themes emerge from the life experiences of women who have undergone hysterectomies in the absence of comprehensive informed consent law?

Nature of the Study

This study will be qualitative in nature. Qualitative study approaches aim to investigate the interpretation individuals give to a social or human problem (Creswell, 2013). Qualitative researchers focus on understanding phenomena in life without giving quantitative aspects, as is the case in quantitative studies. Thus, this study will focus on the attitudes and beliefs of women in Hinds County, Mississippi who have undergone hysterectomies without the presence a comprehensive informed consent law.

The study design approach that best suits the study is the phenomenological approach. Phenomenological approaches are utilized to illuminate and identify phenomena by deciphering how they are viewed by individuals in a situation (Creswell, 2013). It is applied in the human sphere to gather deep information and perceptions through qualitative research methods. The methods could be interviews, observations and discussions, among others (Creswell, 2013). Specifically, the approach focuses on the study of experiences from the perspective of actors.

Owing to its extensive application as a qualitative interview technique in the social and health sciences, this approach would allow the structuring of interviews with predetermined questions (Creswell, 2013). The questions would be modified when necessary to reflect the dynamics of the study. Creswell (2013) asserted that a phenomenological research commences with detailed descriptions of lived circumstances, most often first-person accounts, organized in an everyday language that avoids the use of scholarly and theoretical terms. The approach will enable the researcher to gather a detailed account of the lived experience of women who have undergone hysterectomies. In addition, the strategy will aim to reduce the participants’ personal experiences with a phenomenon to a representation of the shared core.

Sources of Information or Data

1. Surveys of women who will be identified (as explained above) as being childless due to hysterectomy
2. Interviews with women who will be identified as having undergone hysterectomy (procedure for determining unnecessary hysterectomy is explained in the previous section).

The sources of data and/information would be considered well because the validity if the study would be based on the sources of data. In fact, the data that would be collected from women will be analyzed in order to infer about the population. The use of surveys will ensure that enough data would be collected about the topic. The use of interviews will lead to the collection of data with regard to the lived experiences of women who have undergone hysterectomy. The methods would of data collection would utilized while taking into account their advantages and shortcomings. However, in the context of the proposed study, the methods would have more benefits than shortcomings.

References

Bellamy, R. (2004). An introduction to patient education: theory and practice. Medical Teacher, 26(4), 359-365.

Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health communication, 25(8), 661-669.

Creswell, J. W. (2013). Qualitative inquiry & research: Choosing among five approaches (3^rded). Thousand Oaks, CA: Sage Publications.

Fredericks, E. (2013). A Qualitative Study of Women’s Decisions Not to Have a Hysterectomy.Qualitative Report, 18(5), 1-12.

Gómez-Durán, E. L., Mulà-Rosías, J. A., Lailla-Vicens, J. M., Benet-Travé, J., & Arimany Manso, J. (2013). Analysis of obstetrics and gynecology professional liability claims in Catalonia, Spain (1986–2010). Journal of forensic and legal medicine, 20(5), 442-446.

Hussain, M., & Odejinmi, F. (2012). Laparoscopic supracervical hysterectomy: impact of body mass index and uterine weight. Gynecological Surgery, 9(3), 351-355.

Jianjun, Z., Yan, Z., Xiujing, G., &Biru, L. (2013).Psychological status of premenopausal women before and after hysterectomy.Healthmed, 7(8), 2472-2479.

Müller, A., Thiel, F., Renner, S., Winkler, M., Häberle, L., & Beckmann, M. (2010). Hysterectomy – a comparison of approaches. DeutschesAerzteblatt International, 107(20), 353-359.

Papadopoulos, M. S., Tolikas, A. C., &Miliaras, D. E. (2010).Hysterectomy-Current Methods and Alternatives for Benign Indications. Obstetrics &Gynecology International, 2010(1), 1-10.

Preutthipan, S., &Herabutya, Y. (2010).Hysteroscopic rollerball endometrial ablation as an alternative treatment for adenomyosis with menorrhagia and/or dysmenorrhea. Journal of Obstetrics &Gynaecology Research, 36(5), 1031-1036.

Reis, N., Engin, R., Ingec, M., & Bag, B. (n.d). A qualitative study: beliefs and attitudes of women undergoing abdominal hysterectomy in Turkey. International Journal of Gynecological Cancer, 18(5), 921-928.

Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education & Behavior, 2(4), 328-335.

Rott, G. (2012). Hysterectomy Is Mostly Unnecessary. Deutsches Aerzteblatt International, 109(9), 158.

Sheth, S. S. (2010). Vaginal hysterectomy as a primary route for morbidly obese women. Acta obstetricia et gynecologica Scandinavica, 89(7), 971-974.

Sparić, R., Hudelist, G., Berisava, M., Gudović, A., & Buzadzić, S. (2011). Hysterectomy throughouthistory. ActaChirurgicaIugoslavica, 58(4), 9-14.

Vogel, L. (2011). Nursing schools to teach new ways to cope with death. Canadian Medical Association Journal, 183(4), 418-418.

Wu, S. M., Lee, H. L., Yeh, M. Y., & Che, H. L. (2014). Reasons for middle‐aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective. Journal of clinical nursing, 45(23), 1234-1238.