Women in Mississippi Undergoing Hysterectomies Dissertation

Problem Statement

Twelve out of 10,000 women who undergo a hysterectomy die of complications arising from the procedure (Kendall-Raynor, 2007). 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 United States annually are the result of localized illnesses (Fredericks, 2013; National Women’s Health Network, 2005). 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 (Gorlero et al., 2008; Jianjun, Yan, Xiujing& Biru, 2013; Kendall-Raynor, 2007; 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 hysterectomy procedure (Kendall-Raynor, 2007; Preutthipan & Herabutya, 2010). This study will explore the lived experiences of women who have been given the hysterectomy recommendation and undergone the procedure 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 of ensuring appropriate and adequate patient knowledge with regard to hysterectomy during the decision-making process.

It is possible to distinguish two variables that are important for this research. In particular, one should speak about the connection between health literacy and informed consent. In this context, health literacy can be defined as the degree to which a person can understand the information about healthcare services, drugs, or medical procedures (American Medical Association, 2007). In turn, health literacy affects the ability of a person to make informed decisions regarding his/her health. This issue is particularly relevant at the time when informed consent of a patient is required (French & Hernandez, 2013). Hence, a person who does not have health literacy skills is more likely to endanger his/her life and health at the time when he/she has to make choices about different forms of treatment (American Medical Association, 2007). It should be kept in mind that sometimes those patients who have low literacy skills are ashamed of asking physicians about informed consent. As a result, they can become more exposed to various health risks. Thus, these variables are closely related with one another.

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. Hence, the study’s findings have the potential to bring about positive social change in women.

This research can lead to the improvement of health services. In particular, medical workers such as nurses and physicians can better understand the experiences of women who underwent hysterectomies. Thus, healthcare professionals can better educate these women who may not easily cope with the effects of hysterectomy. These women often find it difficult to adjust to the problems, originating from this surgery. This is why educational assistance of medical workers is of great value to them. This is one of the benefits that this study may bring.

Additionally, by understanding the challenges faced by these women, medical workers can better explain the options which are available to women who may need to undergo hysterectomy. In particular, they should fully the effects of this surgery on the health of a person. This is another example of positive social change. Moreover, this study can demonstrate what particular issues are most pertinent to women who may need to undergo hysterectomy. By using the findings of the study, medical workers can help patients take informed decisions. This is one of the positive social changes that should be considered.

Moreover, it may be necessary to provide counseling to women who underwent this surgery in the past. This type of assistance can also be viewed as one of health services. In turn, the results derived in the course of this study can assist such counselors who will be able to work more effectively. Thus, one can say that this research can eventually promote the practices which can improve the experiences of many individuals whose needs could be previously overlooked by medical professionals. So, in this case, one should speak about positive social change.

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 (Bouchez, 2001). 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 (Bouchez, 2001).

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. Kendall-Raynor (2007) and 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. Polk (2006) 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. Van Court (2005) discussed women’s right to choose. Van Court (2005), additionally, described informed consent as it relates to hysterectomies and uterine fibroid removal. Finally, Van Court (2005) 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

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). The HBM is one of several behavioral theories that has 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, Abstract).

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.

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). 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. It will be necessary to recruit subjects who have at least a high school diploma. In this way, one can ensure that the subjects have comparable perceptions of informed consent. They are more likely to act similarly in a medical setting. Much attention should be paid to the patients’ abilities to understand the informed consent. In particular, one should ask several questions about the legal consequences of signing informed consent documents. This precaution can help the researcher to understand the perceptions and attitudes of respondents. Admittedly, the study may become more time-consuming; nevertheless, by asking these questions, one can gain better insights into the decisions of the patients.

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) asserts 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. The approach will aim to reduce the participants’ personal experiences with a phenomenon to a representation of the shared core.

Sources of Information or Data

1. Demographic information of the study participants.
2. Face to face interviews with women who have had first experience with the phenomenon being studied.
3. Support groups for women who have undergone hysterectomies.

References

American Medical Association. (2007). Health Literacy Video. Web.

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

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.

French, M., & Hernandez, L. (2013). Organizational Change to Improve Health Literacy: Workshop Summary. New York, NY: National Academies Press.

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. Web.

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. Web.

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.