Patients' expectations of outcome of hysterectomy and alternative treatments for menstrual problems

Patients can influence treatment to the extent of securing surgery in the absence of medical need, but their-expectations of effects of surgery are poorly understood. Interviews with 26 patients presenting menstrual problems without confirmed pathology were used to construct a questionnaire to measure expectations of effects of treatment. Principal-components analysis of responses of 200 similar patients identified six discrete areas in which improvement was expected, including general well-being, menstrual function, and physical symptoms. Expectations of halm were nonspecific and unidimensional. Component-based scale scores showed that patients who anticipated hysterectomy expected more benefit, but also more harm, than those anticipating conservative procedures. In study 2, these different expectations were largely replicated in patients who were randomly allocated to provide their expectations of specific procedures. Patients' uniquely positive expectations of hysterectomy may help to explain its frequent use in the absence of pathology.