The integration of a woman's perspective in hysterectomy decisions.

It has been argued, based on a limited amount of research data, that patient participation in decision-making regarding surgery, results not only in more patient satisfaction, but also in better surgery outcomes. Especially in a procedure such as hysterectomy, with far-reaching consequences and many potential side effects, it may therefore be relevant to promote an active role of the patient in the decision-making process. The article identifies contextual elements that might promote this active role. Subsequently a model of participative, informed decision-making is outlined. The model entails that clinical guidelines should be adjusted to the particular situation at hand and that patients should be fully informed about hysterectomy-involved risks. An overview of the various guidelines and risks is provided. Proper counseling in the decision-making phase as well as in the post-hysterectomy period is advocated. Throughout the article attention is paid to documented and undocumented ethnic differences regarding various aspects of hysterectomy, particularly differences in patient participation around the world.