Shared Decision-Making to Improve Patient Engagement in Minimally Invasive Hysterectomy

With the increased demand to deliver more value-based and patient-centered health care, shared decision-making (SDM) between patients and physicians has emerged as an important approach to increase patient satisfaction and potentially reduce healthcare costs. Multiple treatment options exist for many health issues, and SDM focuses on educating patients as well as stimulating conversation between patients and physicians about the various treatment options for a specific condition.

Because there is limited evidence on the use of SDM for hysterectomy, AdventHealth gynecologic surgeon Steven D. McCarus, MD, FACOG, launched a feasibility study and quality improvement initiative within his practice to better understand the potential benefits of incorporating a comprehensive SDM model for patients considering minimally invasive surgical (MIS) hysterectomy. This included implementing both structured patient-provider conversations as well as new patient education materials.

To help educate patients on the benefits of an MIS approach to hysterectomy, Dr. McCarus’ practice used a SDM tool developed through a collaboration between Ethicon Endo-Surgery and the Maine Business and Health Coalition. This tool was also endorsed by the American Institute of Minimally Invasive Surgery and the American Association of Gynecological Laparoscopists.

Dr. McCarus’ study included a follow-up survey of 100 patients recommended for minimally invasive hysterectomy. Ninety-seven percent of the patients surveyed indicated that they were satisfied with their decision to undergo a minimally invasive procedure, including laparoscopic total and supracervical hysterectomy, with or without the aid of the robotic platform. In addition, 92 percent of the patients surveyed indicated that they had read the SDM tool, and many anecdotally expressed appreciation for the presentation of care options. Overall, the women were satisfied with the decision process, provider communication and results of the procedure. Furthermore, Dr. McCarus felt the SDM tool improved his relationships with patients while enhancing their education.

The study concluded that implementing a SDM model in a gynecological practice is feasible and increases awareness and engagement as well as satisfaction among patients electing to have a hysterectomy.

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