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A matter of opinion about hysterectomies: experts' and practicing community gynecologists' ratings of appropriateness.

N A Bickell, J Earp, A T Evans and S J Bernstein

Department of Medicine, University of North Carolina, Chapel Hill, USA.

The degree to which national expert panel survey ratings of the appropriateness of hysterectomy differed from those of a random sample of practicing community gynecologists was determined. Community gynecologists rated hysterectomy as more appropriate on six of eight cervical dysplasia scenarios. Experts agreed among themselves on 19 of 32 indications (intraclass correlation coefficient = 0.66); community gynecologists agreed on 12 of 32 indications (intraclass correlation coefficient = 0.50). Although few differences of opinion existed between experts and community gynecologists, for common clinical scenarios there was a large variation of opinion about the appropriateness of hysterectomy within each group. For areas of clinical uncertainty in which experts' opinions are used in guideline development, additional measures such as process of care, quality of life, and patient preference should be included in discussions about guidelines.