Abstract
Background
Approximately one-half of women undergoing hysterectomy in the Department of Veterans
Affairs health care system receive minimally invasive hysterectomies (MIH), with Black
women less likely than White women to receive MIH. We sought to characterize gynecologists’
perspectives on factors contributing to the availability and provision of MIH and
on the role of race/ethnicity in decision making.
Methods
Between October 2017 and January 2018, we conducted 16 in-depth semistructured telephone
interviews with Department of Veterans Affairs gynecologists exploring practice characteristics
and barriers and facilitators to providing MIH, including clinical and nonclinical
characteristics of patients impacting surgical decision making. We identified key
themes using simultaneous deductive and inductive thematic analysis.
Results
Gynecologists identified provider-, facility-, and patient-level barriers and facilitators
to MIH. Provider-level factors included gynecologists' skills and training in MIH,
and facility factors included access to qualified surgical assistants, availability
of surgical equipment, and operating room resources, particularly time. On the patient
level, clinical characteristics, including uterine size, were the most common determinants
of surgical approach, but nonclinical factors such as patients’ attitudes toward surgery
also contributed. Race/ethnicity was identified by a minority of respondents as influencing
hysterectomy route through clinical presentation and surgical attitudes.
Conclusions
Given the range of factors identified, efforts to promote MIH in the Department of
Veterans Affairs will likely require a multipronged approach that includes support
for MIH training, increased access to surgical assistants with MIH skills, and reduced
barriers to obtaining equipment. Patient perspectives are needed to more fully capture
nonclinical patient-level contributors to MIH and differences in MIH between Black
and White Veterans.
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Biography
Kristen E. Gray, PhD, MS, is a Core Investigator, VA Puget Sound Health Services Research & Development, and Research Assistant Professor, University of Washington Department of Health Services. Her research focuses on veterans' reproductive health and health behaviors.
Biography
Erica W. Ma, BA, is a Project Manager, VA Puget Sound Health Services Research & Development Center of Innovation. Her research interests include women veterans' reproductive health.
Biography
Lisa S. Callegari, MD, MPH, is Core Investigator, VA Puget Sound Health Services Research & Development Center of Innovation, and Assistant Professor, University of Washington Department of Obstetrics & Gynecology. Her research focuses on women veterans' reproductive health and health disparities.
Biography
Sara L. Magnusson, BA, is a Project Manager, VA Puget Sound Health Services Research & Development Center of Innovation. Her research interests include comprehensive reproductive health care for all, reproductive autonomy, and expanding access to reproductive health services.
Biography
Erica V. Tartaglione, BS, is a Project Manager, VA Puget Sound Health Services Research & Development Center of Innovation. Her research interests include women veterans' reproductive health and maternity care services.
Biography
Alicia Y. Christy, MD, MHSCR, is the Acting Director and Deputy Director of Reproductive Health, Women's Health Services, Veterans Health Administration. Her research interests are in leiomyoma and health disparities, and the reproductive health of women veterans.
Biography
Jodie G. Katon, PhD, MS, is a Core Investigator, VA Puget Sound Health Services Research & Development Center of Innovation, and Research Assistant Professor, University of Washington Department of Health Services. Her research focuses on reproductive health of women veterans.
Article info
Publication history
Published online: April 03, 2020
Accepted:
February 21,
2020
Received in revised form:
February 11,
2020
Received:
January 30,
2019
Footnotes
Funding Statement: Drs. Gray, Callegari, and Katon were supported by VA Health Services Research & Development Career Development Awards [grant numbers 16–154, 14–412, and 13–266]. This work was also supported by funding from the VA Office of Health Equity. The VA Women's Health Practice Based Research Network is supported by VA Health Services Research & Development Service Directed Research Award [grant number 10–012]. The authors have no conflicts of interest to declare.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
