Hysterectomy is a common,. controversial surgical procedure. Rates of hysterectomy vary widely across small geographic areas in the United States, and these variations have been interpreted as evidence for professional uncertainty about indications for hysterectomy. The proposed study aims to reduce this uncertainty by measuring health and quality-of-life outcomes of hysterectomy and alternative treatments for nonmalignant conditions. The first component of this work is the development of decfision analytic models to define key probabilities and patient utilities driving the hysterectomy decision. The second component is a prospective observational follow-up study of women ages 25 to 50 presenting to gynecologists throughout Maine. The study will survey 500 women undergoing hysterectomy for nonmalignant conditions (including uterine leiomyomata, dysfunctional bleeding, endometriosis, and pelvic inflammatory disease) and 200 women receiving alternative treatments for a limited group of such conditions. Information about symptoms, complications, and quality of life will be obtained over a one-year period. The study will estimate the effect of patient factors such as pre-treatment symptom level on the probability of symptom relief and improved quality of life. Estimates of outcome probabilities and utilities derived from the follow-up study will be incorporated in the decision analytic models. The final component of the sutdy is feedback of these results to practicing gynecologists throughout Maine. The long term dividual patients.
