NSG 6430_W10_Discussion

Prophylactic Hysterectomy • Discuss any “take-away” thoughts from the article. This article examines the aftereffect of prophylactic hysterectomy as the prevalent surgical recommendations for ovarian cancer prevention and associated malignancy in women with increased risk of advancing to ovarian cancer. In this study, the collection of data from the Gilda Radner Familial Ovarian Cancer Registry who had oophorectomy from 1981 to 2002 was utilized by Fisher’s Exact Test as surveillance and assessment for statistical significance. Based on the statistical results of the women being surveyed, the study came up with a conclusion that there is no need for hysterectomy for the malignancy prevention. However, despite of the size limitations of the study, Villella et al. (2006) concluded that women should be screened for benign gynecological manifestations indicating the need for hysterectomy in the process of preparing for a prophylactic surgical intervention for ovarian cancer prevention. Although the role of prophylactic hysterectomy remains unclear, other considerations should be made in considering this surgical recommendation including the importance of meticulous distinction of family histories consistent with strong hereditary predisposition such as endometrial cancer (Villella et al., 2006). • What are the ethical dilemmas to consider with prophylactic surgeries? Preventive surgery aims to reduce cancer risk and mortality, however, there are ethical dilemmas to consider. One of the greatest challenges that patients face in the decision making for prophylactic surgery are exacerbated by the fact that prognoses are uncertain both with or without surgery. Unpredictable side effects of the surgery can occur, therefore, initially, patients worry because of the awareness of the concept of preventive surgery and the ambiguities of the likelihood of detrimental effect of surgery. Another dilemma patients are facing in the decision making is about whether or not to undergo series of surgeries. For instance, in prophylactic mastectomies that can be followed by reconstruction, and oophorectomies, in addition to surgically remove existing lesions (Klitzman & Chung, 2010). Lastly, is the communication with physicians. The interactive communications between physicians, healthcare workers and the patients can often be complicated. Patients typically wants to clear out uncertainties or any doubts and misunderstanding about prophylactic surgery, however, physicians and other healthcare providers may not feel comfortable imparting explicit input and feel torn on wanting to help patients but identifying and realizing eventually that providing a simple definitive opinion may not be beneficial (Klitzman & Chung, 2010). • Discuss the screenings/interventions/options/education that you would provide to a patient that has a strong family history of ovarian cancer. What if the patient has no health insurance? What resources could you offer to assist the patient?