INACCURATE EXPECTATIONS? AFFECTIVE FORECASTING IN THE CONTEXT OF ELECTIVE HYSTERECTOMY

Purpose: To assess the accuracy of women’s emotional expectations of elective hysterectomy as treatment for noncancerous uterine conditions through the lens of affective forecasting.

Methods: This is a secondary analysis of data collected as part of the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives, a longitudinal study designed to examine the effects of noncancerous uterine conditions on health-related quality of life and to identify predictors of use of and satisfaction with hysterectomy and alternative treatments. Patients who had sought care for bleeding, pain, and/or pressure at one of several Bay Area hospitals were interviewed annually for up to eight years. For this analysis, only women who had a hysterectomy were included (n=159).  The primary predictors and outcomes included agreement scores ranging from 1 to 7 on several 1-item attitude measures phrased as expectations prior to hysterectomy and as outcomes post-hysterectomy. Forecasting ability (tendency to accurately estimate, overestimate, or underestimate affective responses) and an overall hysterectomy expectation score were also outcomes.

Results: Compared to their post-hysterctomy scores, before undergoing hysterectomy, participants reported significantly higher agreement with the following statements: “Having a uterus makes/made me feel complete as a woman” (4.08 v. 3.16; p=<0.001), “My uterus is/was important to my sexual enjoyment” (3.51 v. 2.65; p=<0.001), “Having a hysterectomy would make/made me feel violated” (2.77 v. 2.29; p=0.042), and “Having a hysterectomy would make/made me feel older” (3.36 v. 2.65; p=0.006). They showed significantly less agreement with a statement regarding the benefit of hysterectomy as birth control pre-hysterectomy (4.59 v. 5.20; p=0.008). There was no significant change in response to a statement regarding feeling sad about losing fertility (p=0.955). Multinomial logistic regressions revealed few significant associations between forecasting ability and sociodemographic variables. Notable findings include an association between increased age and accuracy of impact of hysterectomy on sexual enjoyment (relative risk ratio=0.82, CI (0.71, 0.93), p=0.003) and between pre-hysterectomy sexual importance and overestimation of hysterectomy's impact on sexual enjoyment (relative risk ratio=1.93, CI (1.23, 3.02), p=0.004).

Conclusions: Women tend to overestimate the impact of perceived negatives associated with hysterectomy, suggesting the presence of forecasting errors. Further exploration of the specific forecasting errors made in the context of elective hysterectomy would aid in the development of more effective decision tools for women considering hysterectomy.