Evaluating preference-sensitive care for uterine fibroids: it's not so simple

Preference-sensitive care decisions should reflect an informed patient's preferences. This retrospective survey of women with fibroids, a benign condition with multiple treatment options, sought to evaluate the extent to which this was measurable and true.

All 260 women in one medical group with visit codes for uterine fibroids during a 9-month period in 2006 were mailed surveys constructed through focus groups with physicians and interviews with patients. Correlations tested associations among their preferences, knowledge, and treatment decisions.

The adjusted response rate was 82%, but only 100 respondents fit all criteria for analysis. Nearly all wanted to either share or control the decision, and 86% felt informed, satisfied, and that the decision was consistent with their values. However, only 55% of patients could answer at least five of seven fibroid questions correctly. Hysterectomy use was significantly correlated with desire to relieve symptoms, have a permanent treatment, and do something right away (r = 0.36, 0.37, and 0.30, respectively). Those deciding not to treat were significantly less likely to have these preferences (r = -0.65, -0.40, and -0.58). These relationships were not affected by patient knowledge level, but patients with high knowledge scores were significantly more likely to believe their decision was concordant with their preferences (94.9% vs. 74.4%, p < 0.01).

There were knowledge gaps but unclear associations between knowledge and decision-preference relationships for this condition, which has many different treatment alternatives. A prospective intervention trial is needed to determine if better information and counseling would produce stronger concordance between treatment selected and patient preferences.