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.