The Influence of Education and Depression on Autonomy of Women with Chronic Pelvic Pain: A Cross-sectional Study

Abstract

Objective Patient autonomy has great importance for a valid informed consent in clinical practice. Our objectives were to quantify the domains of patient autonomy and to evaluate the variables that can affect patient autonomy in women with chronic pelvic pain.

Methods This study is a cross sectional survey performed in a tertiary care University Hospital. Fifty-two consecutive women scheduled for laparoscopic management of chronic pelvic were included. Three major components of autonomy (competence, information or freedom) were evaluated using a Likert scale with 24 validated affirmatives.

Results Competence scores (0.85 vs 0.92; p = 0.006) and information scores (0.90 vs 0.93; p = 0.02) were low for women with less than eight years of school attendance. Information scores were low in the presence of anxiety (0.91 vs 0.93; p = 0.05) or depression (0.90 vs 0.93; p = 0.01).

Conclusions Our data show that systematic evaluation of patient autonomy can provide clinical relevant information in gynecology. Low educational level, anxiety and depression might reduce the patient autonomy in women with chronic pelvic pain.

Resumo

Objetivo A autonomia da paciente é de grande importância para que o consentimento informado seja válido na prática clínica. Nossos objetivos foram quantificar os domínios da autonomia e avaliar variáveis que modificam a autonomia em mulheres com dor pélvica crônica.

Métodos Este é um estudo transversal realizado em um Hospital Universitário terciário. Foram incluídas consecutivamente 52 mulheres com dor pélvica crônica agendadas para videolaparoscopia. Foi utilizada uma escala Likert com 24 afirmativas validadas para quantificar os três principais componentes da autonomia (competência, informação e liberdade).

Resultados Os escores de competência (0,85 vs 0,92; p = 0,006) e informação (0,90 vs 0,93; p = 0,02) foram menores para mulheres com ensino fundamental incompleto. Os escores de informação foram menores em mulheres com sintomas de ansiedade (0,91 vs 0,93; p = 0,05) ou depressão (0,90 vs 0,93; p = 0,01).

Conclusões Nossos dados mostram que a quantificação da autonomia pode produzir informações relevantes para a prática clínica em ginecologia. O nível educacional e a presença de ansiedade e depressão podem afetar a autonomia de mulheres com dor pélvica crônica.

Keywords

autonomy - diagnostic laparoscopy - chronic pelvic pain - education - depression

Palavras-chaves

autonomia - laparoscopia diagnóstica - dor pélvica crônica - educação - depressão

• References

• 1 Tanderup M, Reddy S, Patel T, Nielsen BB. Informed consent in medical decision-making in commercial gestational surrogacy: a mixed methods study in New Delhi, India. Acta Obstet Gynecol Scand 2015; 94 (5) 465-472
• 2 Nijhawan LP, Janodia MD, Muddukrishna BS , et al. Informed consent: Issues and challenges. J Adv Pharm Technol Res 2013; 4 (3) 134-140
• 3 Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press; 2013
• 4 Kang SB, Chung HH, Lee HP, Lee JY, Chang YS. Impact of diagnostic laparoscopy on the management of chronic pelvic pain. Surg Endosc 2007; 21 (6) 916-919
• 5 Auricchio AM, Massarollo MC. [Aesthetic procedures: client's perception regarding the information given for the decision making process]. Rev Esc Enferm USP 2007; 41 (1) 13-20 Portuguese.
• 6 Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003; 4 (7) 407-414
• 7 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (6) 361-370
• 8 Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52 (2) 69-77
• 9 O'Connor AM, Bennett CL, Stacey D , et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2009; (3) CD001431
• 10 Moodley K, Pather M, Myer L. Informed consent and participant perceptions of influenza vaccine trials in South Africa. J Med Ethics 2005; 31 (12) 727-732
• 11 Gallicchio L, Harvey LA, Kjerulff KH. Fear of cancer among women undergoing hysterectomy for benign conditions. Psychosom Med 2005; 67 (3) 420-424
• 12 Kilbridge KL, Fraser G, Krahn M , et al. Lack of comprehension of common prostate cancer terms in an underserved population. J Clin Oncol 2009; 27 (12) 2015-2021
• 13 Stacey D, Légaré F, Col NF , et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014; 1: CD001431
• 14 Kessler RC, McGonagle KA, Zhao S , et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51 (1) 8-19
• 15 Poleshuck EL, Bair MJ, Kroenke K, Watts A, Tu X, Giles DE. Pain and depression in gynecology patients. Psychosomatics 2009; 50 (3) 270-276
• 16 Hindmarch T, Hotopf M, Owen GS. Depression and decision-making capacity for treatment or research: a systematic review. BMC Med Ethics 2013; 14: 54