Improving Patient Understanding of Uterine Fibroid Surgery and Morcellation using Video-enhanced Intervention: A Pilot Feasibility Study
Creators: name: Harris, Benjamin
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: Background: Uterine fibroids affect 80% of women and are the indication for approximately 200,000 surgeries annually in the United States. It is estimated that 63% of these surgeries are done using minimally invasive techniques. Laparoscopic hysterectomy and myomectomy for uterine fibroids are procedures that have been subject to recent controversy when they are paired with morcellation. These complex and controversial procedures provide a platform for investigation and improvement of preoperative patient education techniques. Objectives: (1) To create a complete research design guiding the conduct of a patient centered feasibility study, to be undertaken at a later time, to measure how and why patients prefer different types of counseling/education (usual verbal counseling vs. video enhanced education/counseling) as they approach minimally invasive gynecologic surgery for uterine fibroids; (2) To prepare the investigation with grounding in the literature on the effectiveness of strategies to improve patient understanding, comfort, and satisfaction when they are used to explain a complicated and controversial surgical technique (e.g. morcellation and uterine fibroid surgery) Methods: This is the research design for a multi-site pilot feasibility study aimed at recruiting 150 women undergoing laparoscopic hysterectomy or myomectomy for uterine fibroids where morcellation is anticipated for tissue extraction. The design grounds hypotheses and methods in the literature, develops or modifies educational tools and patient surveys to assess the tools' effectiveness, and considers the recruitment and analysis obstacles associated with such a study. The general design includes proposing to recruit potential study participants at their preoperative surgical consultation. They would be offered the opportunity to participate in the study after the decision to have surgery has been made, but before they sign surgical consent documentation. Those who are willing to participate will sign informed consent documentation. Participants will then proceed with their preoperative consultation visit and receive patient-centered preoperative counseling via their surgeon, after which they would then be offered the opportunity to view a supplemental educational video about their procedure (i.e. laparoscopic hysterectomy or myomectomy). The potential for the educational video to produce distress or discomfort means that randomization is not an appropriate design: patients should have the ability to "opt in" and, even after they have done so, to stop viewing the video if it becomes distressing. The contribution of this design to future research is its patient-centeredness, since it seeks to understand what kinds of patients seek and can benefit from what kinds of education. For these reasons, all participants' completion of a baseline survey and the completion of follow-up surveys is critically important to our ability to analyze differences between patients who seek further education and those who do not, and to understand how those differences may be associated with their operative and postoperative experiences...