Interpretation
From the findings in our study we can conclude that pain reduction
should not be the only motivation for surgery at all costs. This new
insight in patients’ considerations could help in the shared decision
making process and should be considered as an important factor in the
final treatment decision. Pain can negatively impact the quality of
life, but the chance on LARS in more radical surgery due to bowel
resection (faecal incontinence or urgency, frequent or fragmented bowel
movements, emptying difficulties) is also debilitating and has major
impact on the quality of life (36). Therefore DE patients with an
indication for bowel resection should be counselled for the possible
benefits and potential risk of developing permanent intestinal symptoms
(LARS). Consequently, a multidisciplinary approach with SDM should
enable a patient to make a well informed choice that is based on
patients’ preferences and clinical judgement of their treating physician
(gynaecologist/surgeon) to ensure treatment satisfaction and improved
quality of life after the treatment and recovery process.
Regarding surgical fear, women with previous surgery have significant
lower surgical fear compared to women without a surgical history. This
is also an important finding which could be useful in the shared
decision making process. The physician should be aware that women
without surgery might have more fear towards surgery, which could
influence their decision. This is in line with the findings of patients
undergoing cataract surgery, they found lower surgical fear in the group
who underwent the second surgery (37).
However, this information could also mean that women with previous
surgery and less fear have a tendency to choose surgery more easily and
pay less attention to the possible complications or long term side
effects (LARS). The clinician should be aware of both possibility’s when
counseling women (with and without a surgical history) in the SDM
process.