Intermediate Outcomes of Hysterectomy and Alternatives

描述(取自申请人)：建议的申请扩展至我们的 811例非癌症妇女的现有前瞻性纵向研究 子宫切除是合理治疗方案的子宫状况： 异常子宫出血、症状性子宫肌瘤和盆腔 疼痛/子宫内膜异位症。拟议研究的主要目的是1) 确定中期(4-8年)临床和质量- 不同治疗组的生活结局不同(子宫切除、保留子宫 手术或非手术治疗)；以及2) 从广泛的角度开发治疗选择和满意度预测模型 域的数组。拟议扩大现有研究的动机是 有两个主要因素。首先，通过将我们的队列规模增加一个 额外700我们将把平均随访时间从1.7延长到4.1 几年，我们将获得超过976人至少四年的跟踪数据 女人。在四年内增加样本将使我们能够积累足够的 接受子宫切除术和非手术治疗的妇女人数 这是一个具有统计学意义的比较。因为患有非癌症的女性的症状 子宫疾病通常从40岁出头的S延伸到 更年期，包括中期，面临着这个决定，提供了有用的 信息将帮助妇女和她们的医生获得信息， 共同的决定。第二，我们将加强我们的性功能测量， 抑郁和大小便失禁，并包括对最新可用的 另类治疗。这些补充反映了理解上的变化 这些因素在非癌子宫治疗中的作用 自最初研究开始以来的情况。这样做的结果 研究是我们改善决策的长期目标的核心 非癌性子宫疾病的管理。这些发现来自于 拟议的研究将与循证研究的发展有关 指导方针和创建决策辅助工具，以帮助妇女 非癌性子宫疾病做出明智的选择 在他们面临子宫切除风险的十年中接受治疗。

DESCRIPTION (TAKEN FROM APPLICANT): The proposed application expands on our existing prospective longitudinal study of 811 women with non-cancerous uterine conditions for which hysterectomy is a reasonable treatment option: abnormal uterine bleeding, symptomatic uterine leiomyomata, and pelvic pain/endometriosis. The principal aims of the proposed study are to 1) determine whether and how intermediate-term (4-8 year) clinical and qualityof- life outcomes differ by treatment group (hysterectomy, uterus-preserving surgery, or non-surgical treatments) for their uterine conditions; and 2) develop predictive models of treatment choice and satisfaction from a broad array of domains. The proposed expansion of the existing study is motivated by two main factors. First, by increasing the size of our cohort by an additional 700 we will extend the mean duration of follow-up from 1.7 to 4.1 years, and we will obtain at least four years of follow-up data on over 976 women. The increased sample at four years will allow us to accrue an adequate number of women undergoing hysterectomy and non-surgical treatments to support a statistically meaningful comparison. Because symptoms for women with noncancerous uterine conditions typically extend from the early 40?s to menopause, including intermediate-term, face this decision, providing useful information will help equip women and their physicians to make informed, shared decisions. Second, we will enhance our measures of sexual functioning, depression, and incontinence, and include assessments of newly available alternative treatments. These additions reflect changes in the understanding of the role of these factors in the management of non-cancerous uterine conditions since the inception of the original study. The results of this study are central to our long-term goal of improving decision making in the management of non-cancerous uterine conditions. The findings that emerge from the proposed study will be relevant to the development of evidence-based guidelines and the creation of decision-assisting tools to help women with non-cancerous uterine conditions make informed choices regarding their treatment during their decade of risk for hysterectomy.