Objective To investigate patient preferences for endometrial ablation and a le vonorgestrel-releasing intrauterine device (IUD) as alternatives to hysterectom y in the treatment of dysfunctional uterine bleeding. Design Comparative study b ased on structured interviews. Setting A large teaching hospital with 500 beds i n the Netherlands. Patient(s) Ninety-six patients who were scheduled for endome trial ablation, 25 patients who were scheduled for hysterectomy, and 23 patients who were scheduled for a levonorgestrel-releasing IUD were interviewed. All of the women had dysfunctional uterine bleeding. Intervention( s) Patients were as ked to state their most significant complaints and their reasons for choosing a particular treatment. Subsequently, the preference for endometrial ablation and a levonorgestrel-releasing IUD as alternatives to hysterectomy was assessed dur ing a structured interview. Women were informed about the advantages and disadva ntages of all three treatment options. Patients rated their preferences accordin g to different hypothetical success rates. The success rates after endometrial a blation and levonorgestrel-releasing IUD were varied until patients found an ac ceptable treatment outcome. Main outcome measure(s) Patient preference of endome trial ablation and the levonorgestrel-releasing IUD over hysterectomy. Result(s ) The main reason for the treatment of choice differed between the three groups. Most of the patients in the hysterectomy group wanted a definite solution to th eir problems, whereas patients in the levonorgestrel-releasing IUD group and in the ablation group put greater emphasis on a minimally invasive intervention wi th or without a short hospital stay. In women undergoing ablation, 70%of the pa tients preferred this treatment and the levonorgestrel-releasing IUD to hystere ctomy in cases in which the success rate of noninvasive treatment was presumed t o be 50%. Inwomen having a levonorgestrel-releasing IUD inserted, 95%of the p atients preferred this approach over hysterectomy in cases in which the success rate of this device was presumed to be 50%, whereas 35%of patients preferred a blation over hysterectomy in cases in which the success rate of ablation was pre sumed to be 50%. In women undergoing hysterectomy, 30%would have opted for abl ation and 45%would have opted for a levonorgestrel-releasing IUD in cases in w hich success rates were 50%. Of patients who opted for hysterectomy, however, 6 0%stated that they would have preferred a noninvasive treatment if the success rate of this type of treatment were >80%. Conclusion(s) A majority of the patie nts who had dysfunctional uterine bleeding and who were scheduled for an endomet rial ablation or a levonorgestrel-releasing IUD were inclined to take a risk of 50%likelihood of treatment failure to avoid a hysterectomy. As a consequence, research of treatment for dysfunctional uterine bleeding should focus on this 5 0%success level.
展开▼
