Development and preliminary evaluation of a clinical guidance programme for the decision about prophylactic oophorectomy in women undergoing a hysterectomy
Objectives: To develop a decision analysis based and computerised clinical guidance programme
(CGP) that provides patient specific guidance on the decision whether or not to undergo a prophylactic
oophorectomy to reduce the risk of subsequent ovarian cancer and to undertake a preliminary pilot
and evaluation.
Subjects: Women who had already agreed to have a hysterectomy who otherwise had no ovarian
pathology.
Setting: Oophorectomy decision consultation at the outpatient or pre-admission clinic.
Methods: A CGP was developed with advice from gynaecologists and patient groups, incorporating
a set of Markov models within a decision analytical framework to evaluate the benefits of undergoing
a prophylactic oophorectomy or not on the basis of quality adjusted life expectancy, life expectancy,
and for varying durations of hormone replacement therapy. Sensitivity analysis and preliminary testing
of the CGP were undertaken to compare its overall performance with established guidelines and practice.
A small convenience sample of women invited to use the CGP were interviewed, the interviews
were taped and transcribed, and a thematic analysis was undertaken.
Results: The run time of the programme was 20 minutes, depending on the use of opt outs to default
values. The CGP functioned well in preliminary testing. Women were able to use the programme and
expressed overall satisfaction with it. Some had reservations about the computerised format and some
were surprised at the specificity of the guidance given.
Conclusions: A CGP can be developed for a complex healthcare decision. It can give evidence-based
health guidance which can be adjusted to account for individual risk factors and reflects a patient’s
own values and preferences concerning health outcomes. Future decision aids and support systems
need to be developed and evaluated in a way which takes account of the variation in patients’ preferences
for inclusion in the decision making process
