Jane Moore1, Sue Ziebland, Stephen Kennedy. 1. Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. janemoore@btinternet.com
Abstract
OBJECTIVES: To explore women's views about the risks and benefits of diagnostic laparoscopy in the investigation of chronic pelvic pain, including how much information it is thought appropriate to give about three specific risks: death, major complications and the chance that the procedure would have an inconclusive result. DESIGN: A qualitative analysis of semi-structured, audio-taped interviews with 20 women about their experiences of undergoing a diagnostic laparoscopy in a day surgery unit. Interviews were conducted 3-6 months after the procedure. RESULTS: All the women who were interviewed were aware that diagnostic laparoscopy carried risks, including the small risk of death associated with general anaesthesia. One-third of respondents said that they had initially been reluctant to discuss the risks of the procedure in general terms. However, when specific examples of complications and risks were introduced all but one of the respondents reported that they would have liked to discuss these at the time that the decision to have the operation was made. Women maintained that the information was needed to make an informed decision about whether to have the operation, to help them understand and cope should things go wrong and in order to make appropriate plans to cover contingencies. Most were surprised to hear that the procedure is frequently inconclusive and thought that this information should be made clear to women contemplating a laparoscopy. CONCLUSIONS: Women undergoing diagnostic laparoscopy for the investigation of chronic pelvic pain wish to be given full and accurate information about complication rates such as bowel perforation, what to expect during their recovery, and the chances of finding a cause for their pain. Although they may not want to dwell on the risk of death, they do need to be informed about the specific risks associated with the procedure in order to make a balanced decision.
OBJECTIVES: To explore women's views about the risks and benefits of diagnostic laparoscopy in the investigation of chronic pelvic pain, including how much information it is thought appropriate to give about three specific risks: death, major complications and the chance that the procedure would have an inconclusive result. DESIGN: A qualitative analysis of semi-structured, audio-taped interviews with 20 women about their experiences of undergoing a diagnostic laparoscopy in a day surgery unit. Interviews were conducted 3-6 months after the procedure. RESULTS: All the women who were interviewed were aware that diagnostic laparoscopy carried risks, including the small risk of death associated with general anaesthesia. One-third of respondents said that they had initially been reluctant to discuss the risks of the procedure in general terms. However, when specific examples of complications and risks were introduced all but one of the respondents reported that they would have liked to discuss these at the time that the decision to have the operation was made. Women maintained that the information was needed to make an informed decision about whether to have the operation, to help them understand and cope should things go wrong and in order to make appropriate plans to cover contingencies. Most were surprised to hear that the procedure is frequently inconclusive and thought that this information should be made clear to women contemplating a laparoscopy. CONCLUSIONS:Women undergoing diagnostic laparoscopy for the investigation of chronic pelvic pain wish to be given full and accurate information about complication rates such as bowel perforation, what to expect during their recovery, and the chances of finding a cause for their pain. Although they may not want to dwell on the risk of death, they do need to be informed about the specific risks associated with the procedure in order to make a balanced decision.
Authors: L J Convie; E Carson; D McCusker; R S McCain; N McKinley; W J Campbell; S J Kirk; M Clarke Journal: BMC Med Ethics Date: 2020-07-11 Impact factor: 2.652