"Someone could have told me": a qualitative study on experiences with hysterectomy decision-making and regret in Mysore, India.

Introduction: Hysterectomy is a common surgery among women in India and has been normalized as a treatment for a range of conditions including those with alternative treatment options. There are concerns regarding its overuse, appropriateness, and potential contribution to poor health outcomes, especially among younger women. As with all surgical decision-making, it can be a challenge to balance patient autonomy with physician expertise in decision-making. Methods: We performed in-depth interviews with 20 women who had undergone hysterectomy prior to age 35 in semi-urban areas of Mysore District, Karnataka, India to gain insights around their decision-making experiences. Transcripts were evaluated using thematic analysis, and we used the Ottawa Decision Support Framework to frame our findings around three key domains: decision impact, status and gaps in decisional support, and ongoing decisional needs. Results: Participants described positive outcomes when personal values were aligned with decision-making, and regret when they were not aligned. They often felt under-supported in decision-making. Key resources in decision-making were from community members and medical personnel. Finally, participants identified a gap in formal support in place for women considering hysterectomy and highlighted the need for better counseling by medical providers. Discussion: Recommendations for improving decisional support and minimizing decisional regret include expanding education by community health workers regarding gynecologic health, personalized and accurate discussion of health conditions and personal values by physicians, increased government oversight of hysterectomy, and expanded access to routine healthcare to increase treatment options.