Grant: Project Grant

There are 40,000 hysterectomies each year in Canada. Hysterectomy is often used to treat non-cancerous gynaecologic conditions like uterine fibroids, but carries short-term risks of complications and long-term risks of chronic disease. Physician guidelines thus recommend hysterectomy for specific clinical indications only when there are no other effective treatments. However, while there are medical treatments for many gynaecologic disorders, hysterectomy remains the most common non-obstetric surgery in females, and hysterectomy rates, more invasive surgical approaches, and complications are higher in groups experiencing poverty and other social risk factors. One-quarter of Canadians have a physical, hearing, vision, or developmental disability, and their healthcare tends to focus on their disability rather than their reproductive healthcare needs. Yet, few studies have examined hysterectomy in this group. Our goal is to create knowledge about hysterectomy for non-cancer indications in Canadians with disabilities. We will use whole-population medical records in Ontario to compare hysterectomy rates, characteristics, and complications in females with and without disabilities. We will also use interviews with females with disabilities who had a hysterectomy or a clinical consultation about hysterectomy in the last 5 years, family care partners, and physicians, to understand when, why, and how hysterectomy takes place in this population and identify strategies and opportunities to improve care. Our data will impact healthcare delivery by providing evidence needed to develop clinical guidelines, healthcare provider training, patient education tools, and post-operative care approaches that consider the needs of patients with disabilities. Efforts to improve equity and inclusion in reproductive healthcare for individuals with disabilities considering, or undergoing, hysterectomy will ultimately improve the health of Canadians across the reproductive life course.