Teen, Parent, and Clinician Expectations About Obesity and Related Conditions During the Annual Well-Child Visit

Purpose: This study aimed to examine family (patient, parent/guardian) and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit. Methods: Four focus groups with teen patients (n = 16), four focus groups with parents (n = 15) and one focus group with providers (n = 12) were conducted using a structured moderator guide tailored to each population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia or elevated blood pressure. Parents who attended their child’s well-child visit and whose child met the diagnostic criteria were eligible. Teen focus groups were divided by gender (male/female) and age (14–15/16–17 years). Focus group transcripts were coded for concepts and themes using qualitative data and thematic analysis. Analysis was performed across groups to determine common themes and domains of intersect. Results: Teens and parents expect weight to be discussed at well-child visits and prefer discussions to come from a trusted clinician who uses serious, consistent language. Teens did not recognize the health implications from excess weight, and both parents and teens express the need for more information on strategies to change behavior. Providers recognize several challenges and barriers to discussing weight management in the well-child visit. Conclusions: A clinician-teen-family relationship built on trust, longevity, teamwork, support and encouragement can create a positive atmosphere and may improve understanding for weight-related messages for teens and families during a well-child visit

Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration

INTRODUCTION: Uterine fibroids are the most common indication for hysterectomy. Minimally invasive hysterectomy (MIH) confers lower risk of complications and shorter recovery than open surgical procedures; however, it is more challenging to perform with larger fibroids. There are racialized differences in fibroid size and MIH rates. We examined the role of uterine size in black-white differences in MIH among Veterans in the Department of Veterans Affairs (VA). METHODS: Using VA clinical and administrative data, we conducted a cross-sectional study among black and white Veterans with fibroids who underwent hysterectomy between 2012 and 2014. We abstracted postoperative uterine weight from pathology reports as a proxy for uterine size. We used a generalized linear model to estimate the association between race and MIH and tested an interaction between race and postoperative uterine weight (≤250 g vs. \u3e250 g). We estimated adjusted marginal effects for racial differences in MIH by postoperative uterine weight. RESULTS: The sample included 732 Veterans (60% black, 40% white). Postoperative uterine weight modified the association of race and MIH (p for interaction=0.05). Black Veterans with postoperative uterine weight ≤250 g had a nearly 12-percentage point decrease in MIH compared to white Veterans (95% CI -23.1 to -0.5), with no difference by race among those with postoperative uterine weight \u3e250 g. DISCUSSION: The racial disparity among Veterans with small fibroids who should be candidates for MIH underscores the role of other determinants beyond uterine size. To eliminate disparities in MIH, research focused on experiences of black Veterans, including pathways to treatment and provider-patient interactions, is needed

Patient Perceptions of Planned Organ Removal During Hysterectomy

Purpose: Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women’s self-reported expectations of how they think their anatomy will change after hysterectomy. Methods: Women scheduled for hysterectomy at a tertiary care hospital, for non-oncological reasons, reported their planned procedure type and the organs they understood would be removed 2 weeks prior to surgery. Patient reports and electronic medical records were reviewed, and kappa statistics (κ) were calculated to assess agreement for all women and within subgroups. Results: Most of the 456 study participants (mean age: 48.02 ± 8.29 years) were either white/Caucasian (n = 238, 52.2%) or African American (n = 196, 43.0%). Among the 145 participants who reported a partial hysterectomy, 130 (89.7%) women indicated that their uterus would be removed and 52 (35.9%) reported that their cervix would be removed. Of those whose response was total hysterectomy (n = 228), 208 (91.2%) participants reported their uterus would be removed and 143 (62.7%) reported their cervix would be removed. Among 144 women reporting a planned partial hysterectomy, only 15 (10.4%, κ = 0.05) had a partial hysterectomy recorded in the electronic medical record. Among the 228 women who reported a planned total hysterectomy, 6.1% (κ = 0.05) had a different procedure. While 125 participants reported planned ovary removal, only 93 (74.4%, κ = 0.55) had an oophorectomy. Similarly, 290 participants reported planned fallopian tube removal, with 276 (95.2%, κ = 0.06) having a salpingectomy. Conclusions: A considerable proportion of women undergoing hysterectomy do not accurately report the organs that are planned be removed during their hysterectomy. This work demonstrates the need to improve patient understanding of their clinical care and its implications

Association between patient depression level and hysterectomy satisfaction.

Study Objective: In the U.S., hysterectomy is the most common nonobstetrical surgery for women. However, there have been few investigations into understanding factors, such as depression, related to procedure satisfaction. Design: Prospective Cohort Study. Setting: Henry Ford Health System. Patients: Women planning hysterectomy for non-cancer indications. Intervention: Hysterectomy by any route. Measurements and Main Results: Methods:Women who had planned to have a hysterectomy at Henry Ford health System in Detroit for noncancer reasons, were recruited via telephone for longitudinal study. These are data from 121 women who had their surgery ≥6 months ago. Women reported procedure satisfaction (response of “agreed” or “strongly agreed” vs. “neither agree nor disagree”, “disagree” or “strongly disagree” with the following: “I was satisfied with my decision.”) within 14 days prior to surgery and at 1, 4, and 6-weeks, and 3 and 6-months post-surgery. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depression severity.Wilcoxon signed-rank tests were used to assess associations between PHQ-9 scores and satisfaction at each time-point. Results: Average participant age was 46.7 years (SD = 8.4, range = 30-64 years) and 49.6% self-identified as Black. Mean ± SD PHQ-9 scores at each time point were: 6.2 ± 6.0, 4.0 ± 4.4, 3.4 ± 3.9, 3.2 ± 3.7, 3.7 ± 5.0, and 3.4 ± 4.9. Percentages of women who reported being satisfied at each time point are: 95%, 77.7%, 72.7%, 76.0%, 76.0% and 76.9%. PHQ-9 depression scores were associated with post-surgical satisfaction only at 1-week and 3-months post-surgery (p \u3c .001). Mean depression scores for “satisfied” versus “unsatisfied” participants were: 1 week, 3.6 (SD = 4.4) versus 6.0 (SD = 4.7); and 3 months, 3.18 (SD = 4.6) and 6.3 (SD = 5.4). Conclusion: Recruitment and follow-up are ongoing, thus analyses will continue with a larger sample size as these preliminary data suggest depression may be associated with procedural satisfaction in the early post-surgical period

Do women express regret after hysterectomy?

Study Objective: To investigate regret after hysterectomy over time. Design: Prospective Cohort Study. Setting: Henry Ford Health System, Detroit, MI. Patients:Women who had planned to have a hysterectomy for non-cancer reasons. Intervention: Hysterectomy by any route. Measurements and Main Results: Women were recruited via telephone for this longitudinal study. 346 women are currently enrolled in the study and these are data from those 73, who had their surgery ≥1 year ago. They completed questionnaires about their health and decision to have a hysterectomy within 14 days prior to surgery and at 3,6 and 12-months postsurgery. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depression severity. The Decision-Regret Scale was used to assess regret. Of these 73 cases, 24 were open and 49 underwent minimally invasive hysterectomy(MIH).Median uterine weight was 371 gm in open vs 150 gm for the MIH. Overall, mean±SD Decision-Regret scores at baseline and 12 (Table presented) months were: 10.6.0 ± 1.5 and 9.7 ± 2.0. At 1 year after surgery, the Decision-Regret scores were 10.3 ± 2.3 in the open and 9.5 ± 1.9 in the MIH group; these mean scores were lower than the mean scores in the 14 days prior to surgery 11.3 ± 1.8 in the open group and 10.5 ± 1.4 in the MIH group., and also lower than at 3 and 6 months. Also, overall, the pain and depression scores in both groups decreased over time as well, even though the MIH group started off with slightly higher scores for pain (2.9 ± 3.0 vs 1.5 ± 2.5), and depression (5.9 ± 5.1 vs 4.4 ± 4.6). Conclusion: Preliminary data suggest that women do not express regret after hysterectomy, regardless of route. It appears that the MIH group has smaller uteri, are younger and have higher pain and depression scores at baseline. Recruitment and follow-up are ongoing, thus analyses will continue with a larger sample size

Development of a Composite Risk Index of Reproductive Autonomy Using State Laws: Association With Maternal and Neonatal Outcomes

OBJECTIVE: We developed a composite index to quantify state legislation related to reproductive autonomy and examined its association with maternal and neonatal outcomes. We hypothesized that greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. DESIGN: A Delphi panel was used to inform development of the index. Restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data were used to conduct a cross-sectional study among all live births in the 50 U.S. states to people aged 15 to 44 between January 1, 2016, and December 31, 2018, to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. We used linear regression with state scores and quartiles, adjusted for state-level proportions of White, Black, and Hispanic live births; percent living in rural areas; percent of population foreign born; Health Resources and Services Administration spending on maternal and child health; and the Opportunity Index, a composite measure of indicators of the economy, education, and community. RESULTS: From 2016 to 2018, there were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM. The Delphi panel resulted in a summed state measure of 106 laws in 8 categories that could affect reproductive autonomy. In adjusted analyses, states in the most enabling (most reproductive autonomy) quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile (least reproductive autonomy). CONCLUSIONS: A composite policy index of reproductive autonomy was found to be associated with higher rates of SMM but lower rates of PRM and PTB. Further research is needed to understand how reproductive autonomy in the cumulative index may influence these and other maternal and birth outcomes

Identifying What Matters to Hysterectomy Patients: Postsurgery Perceptions, Beliefs, and Experiences

Purpose: Hysterectomy is the most common nonobstetrical surgery for women in the United States. Few investigations comparing hysterectomy surgical approaches include patient-centered outcomes. Methods: The study was performed at Henry Ford Health System (Detroit, MI) between February 2015 and May 2015. A total of 1,038 eligible women — those 18 to 65 years of age and who had an electronic medical record-documented Current Procedural Terminology (CPT®) code or an International Statistical Classification of Diseases, Ninth Edition (ICD-9) code of hysterectomy between December 2012 and December 2014 — were selected and recruited. A question guide was developed to investigate women’s experiences and feelings about the experience prior and subsequent to their hysterectomy. Analysis utilized the Framework Method. Study data were collected through structured focus groups with 24 posthysterectomy women in order to identify patient-centered outcomes to employ in a subsequent cohort study of hysterectomy surgical approaches. One pilot focus group and 5 additional focus groups were held. Qualitative data analysis, using data from coded transcripts of focus groups, was used to identify themes. Results: Focus groups with women who previously had a hysterectomy revealed their pre- and posthysterectomy perceptions. Responses were grouped into topics of pre- and postsurgical experiences, and information all women should know. Themes derived from responses: 1) decision-making; 2) the procedure (surgical experience); 3) recovery; 4) advice to past self; and 5) recommendations to other women. Conclusions: These analyzed data suggest a need for increased education and empowerment in the hysterectomy decision-making process, along with expanding information given for postoperative expectations and somatic changes that occur posthysterectomy. Findings about perceptions, beliefs, and attitudes of women having undergone hysterectomy could support health care providers deliver more patient-centered care

Identifying What Matters to Hysterectomy Patients: Postsurgery Perceptions, Beliefs, and Experiences

Purpose: Hysterectomy is the most common nonobstetrical surgery for women in the United States. Few investigations comparing hysterectomy surgical approaches include patient-centered outcomes. Methods: The study was performed at Henry Ford Health System (Detroit, MI) between February 2015 and May 2015. A total of 1,038 eligible women — those 18 to 65 years of age and who had an electronic medical record-documented Current Procedural Terminology (CPT®) code or an International Statistical Classification of Diseases, Ninth Edition (ICD-9) code of hysterectomy between December 2012 and December 2014 — were selected and recruited. A question guide was developed to investigate women’s experiences and feelings about the experience prior and subsequent to their hysterectomy. Analysis utilized the Framework Method. Study data were collected through structured focus groups with 24 posthysterectomy women in order to identify patient-centered outcomes to employ in a subsequent cohort study of hysterectomy surgical approaches. One pilot focus group and 5 additional focus groups were held. Qualitative data analysis, using data from coded transcripts of focus groups, was used to identify themes. Results: Focus groups with women who previously had a hysterectomy revealed their pre- and posthysterectomy perceptions. Responses were grouped into topics of pre- and postsurgical experiences, and information all women should know. Themes derived from responses: 1) decision-making; 2) the procedure (surgical experience); 3) recovery; 4) advice to past self; and 5) recommendations to other women. Conclusions: These analyzed data suggest a need for increased education and empowerment in the hysterectomy decision-making process, along with expanding information given for postoperative expectations and somatic changes that occur posthysterectomy. Findings about perceptions, beliefs, and attitudes of women having undergone hysterectomy could support health care providers deliver more patient-centered care

Identifying What Matters to Hysterectomy Patients: Postsurgery Perceptions, Beliefs, and Experiences.

Purpose: Hysterectomy is the most common non-obstetrical surgery for women in the United States. Few investigations comparing hysterectomy surgical approaches include patient-centered outcomes. Methods: The study was performed at Henry Ford Health System in Detroit, Michigan between February 2015 and May 2015. The data were collected through structured focus groups with 24 post-hysterectomy women in order to identify PCOs to employ in a subsequent cohort study of hysterectomy surgical approaches. One pilot focus group and five additional focus groups were held. Qualitative data analysis, using data from coded transcripts of focus groups, was used to identify themes.Eligible women, aged between 18 and 65 years and had an EMR documented Current Procedural Terminology (CPT™) code or an International Statistical Classification of Diseases and Related Health Problems - Ninth Edition (ICD-9) code of hysterectomy between December 2012 and December 2014 (N=1,381, N=307 after exclusions) were selected and recruited. A question guide was developed to investigate women\u27s experiences and feelings about the experience prior and subsequent to their hysterectomy. Analysis utilized the Framework Method. Results: Focus groups with women who previously had a hysterectomy revealed their pre- and post-hysterectomy perceptions. Responses grouped into topics of pre- and post-surgical experiences, and information all women should know. Responses grouped into themes of 1) decision making, 2) the procedure - surgical experience, 3) recovery, 4) advice to past self, and 5) recommendations to other women. Conclusion: These findings about perceptions, beliefs, and attitudes of women having undergone hysterectomy could support health care providers deliver patient-centered care. These results informed data collection for a prospective longitudinal cohort study that is now underway. The data suggest a need for increased education and empowerment in the decision making process, while expanding on information given for post-operative expectations and somatic changes that occur post-hysterectomy

Weight-Related Messages in Well-Child Visits: What Do Teens Desire?

Background/Aims: With the United States’ prevalence of childhood obesity at approximately 17%, well-child visits are a critical time to discuss well-being, physical activity and other concerns. Discussion of healthy weight is a key component of these pediatric visits. Appropriate delivery of weight-related messages to adolescents and their families is critical. Accusatory messages may distance adolescents from health care, whereas nondirect approaches could suggest unhealthy weight is nonproblematic. Feedback on weight-related messages during the well-child visit may improve health care delivery in this setting. Methods: Opinions on weight, weight-related messaging, blood pressure and lipid testing knowledge were collected through focus groups with adolescents 14–18 years old. Eligible adolescents had a body mass index \u3e 85th percentile and/or a diagnosis of high blood pressure or high cholesterol. A framework matrix method was used for data analysis. Results: Four focus groups, stratified by gender, were held (16 participants [9 male]; mean age 15.7 ± 1.05 years). Teens expressed that a relationship based on provider trust, built over time, with personal and parental responsibility, are important aspects of the well-child “team.” Adolescents voiced strong desire for parental inclusion in health-related discussions. Ideal parental involvement was described as supportive and encouraging to provider recommendations. Teens expressed a lack of knowledge and awareness, along with misconceptions, about health consequences due to unhealthy weight, blood pressure and cholesterol. Providers were described as a resource to discuss weight-related topics; teens expected and welcomed weight-related conversations. Adolescents appreciated casual conversations based on activities and interests, although a serious approach was considered helpful to encourage meaningful changes. Discussions about blood pressure, cholesterol and diabetes were categorized as “scary” and “overwhelming.” Conclusion: Our data suggest a provider-adolescent relationship built on trust, team work, support and encouragement creates a positive atmosphere for weight-related messages for teens during a well-child visit. Adolescents described long-standing patient-provider histories, suggesting a pediatric medical home concept may be critical in positive discussions of weight. Next steps include analyzing similar parent and provider focus group data and incorporating focus group concepts into a patient-centered, brief, educational intervention for providers focusing on weight-related messages during the well-child visit