SCOPE REVIEW PROTOCOL

 

QUALITY OF LIFE IN THE PREOPERATIVE PERIOD OF HYSTERECTOMY: SCOPING REVIEW PROTOCOL

 

CALIDAD DE VIDA EN EL PERIODO PREOPERATORIO DE LA HISTERECTOMÍA: PROTOCOLO DE REVISIÓN DEL ALCANCE

 

QUALIDADE DE VIDA NO PERÍODO PRÉ-OPERATÓRIO À HISTERECTOMIA: PROTOCOLO DE REVISÃO DE ESCOPO

https://doi.org/10.31011/reaid-2025-v.99-n.3-art.2495

 

1Lara Beatriz de Sousa Coelho

2Eugênio Barbosa de Melo Júnior

3Maria Zélia de Araújo Madeira

 

1Enfermeira. Mestranda em Enfermagem, Programa de Pós-Graduação em Enfermagem, Universidade Federal do Piauí, Teresina, Piauí, Brazil. Orcid: https://orcid.org/0000-0002-8640-7172

2Enfermeiro. Doutor em Enfermagem pela Universidade Federal do Piauí. Possui Graduação em Enfermagem e Mestrado em Ciências e Saúde pela Universidade Federal do Piauí. Teresina, Piauí, Brazil. Orcid: https://orcid.org/0000-0002-0444-2960

3Enfermeira. Doutora em Ciências Médicas pela Universidade Estadual de Campinas - UNICAMP e Mestre em Educação pela UFPI. Docente da Graduação e da Pós-Graduação em Enfermagem do Departamento de Enfermagem e do Programa de Pós-Graduação em Ciência e Saúde da Universidade Federal do Piauí, Teresina, Piauí, Brazil. Orcid: https://orcid.org/0000-0003-2877-2806

 

Corresponding Author

Lara Beatriz de Sousa Coelho

Rua Aarão Reis, nº 903, Caxias, Maranhão – Brazil. Contact: +55 (99) 98404-9821; E-mail: larabiacoelho@gmail.com

 

Submission:  14-02-2025

Approval: 09-09-2025

 

ABSTRACT

Objective: To map the evidence available in the scientific literature on how Quality of Life is affected in the preoperative period of Hysterectomy. Method: This is a scoping review protocol, structured according to the Manual for Evidence Synthesis of the Joanna Briggs Institute (JBI), and aligned with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) Checklist. The following sources of information will be consulted: Cumulative Index to Nursing Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Web of Science, Scopus, Bibliographic Index of Latin American and Caribbean Literature in Health Sciences, as well as in the gray literature: Brazilian Digital Library of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel, ProQuest Dissertations and Theses and Google Scholar. The literature review will be conducted from February to May 2025 by two independent and blind reviewers simultaneously. The research question was formulated based on the mnemonic PCC (Population, Concept, Context), considering: Women in the preoperative period (Population); Quality of life (Concept of Interest) and Gynecological Hysterectomy Surgery (Context). The question raised was: “What scientific evidence is found on how Quality of Life is affected in the preoperative period of Hysterectomy?”. Studies with different methodological approaches will be included, without temporal and/or idiomatic restrictions. The search results will be described using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. The protocol for this review was registered on the Open Science Framework platform (https://osf.io/fc26v/).

Keywords:  Hysterectomy; Quality of Life; Preoperative Period.

 

RESUMO

Objetivo: Mapear as evidências disponíveis na literatura científica sobre como Qualidade de Vida é afetada no período pré-operatório à Histerectomia. Método: Trata-se de um protocolo de revisão de escopo, estruturado conforme o Manual for Evidence Synthesis do Joanna Briggs Institute (JBI), e alinhado ao Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) Checklist. Serão consultadas as seguintes fontes de informação: Cumulative Index to Nursinge Allied Health Literaure, Medical Literature Analysis and Retrievel System Online, Web of Science, Scopus, Índice Bibliográfico Literatura Latino-Americana e do Caribe em Ciências da Saúde, bem como na literatura cinzenta: Biblioteca Digital Brasileira de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, ProQuest Dissertations and Theses e no Google Acadêmico. O levantamento bibliográfico será realizado de fevereiro a maio de 2025 por dois revisores independentes e às cegas de maneira simultânea. A questão de pesquisa foi elaborada com base no mnemônico PCC (População, Conceito, Contexto), considerou-se: Mulheres no período pré-operatório (População); Qualidade de vida (Conceito de Interesse) e Cirurgia ginecológica de Histerectomia (Contexto). A questão traçada foi: “Quais as evidências científicas encontradas sobre como Qualidade de Vida é afetada no período pré-operatório à Histerectomia?”. Serão incluídos estudos com diferentes abordagens metodológicas, sem restrição temporal e/ou idiomática. Os resultados das buscas serão descritos por meio do fluxograma Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). O protocolo desta revisão foi registrado na plataforma Open Science Framework (https://osf.io/fc26v/).

Palavras-chave: Histerectomia; Qualidade de Vida; Período Pré-Operatório.

 

RESUMEN

Objetivo: Mapear la evidencia disponible en la literatura científica sobre cómo se afecta la Calidad de Vida en el periodo preoperatorio posterior a la Histerectomía. Método: Se trata de un protocolo de revisión de alcance, estructurado de acuerdo con el Manual de síntesis de evidencia del Instituto Joanna Briggs (JBI), y alineado con la lista de verificación de elementos de informe preferidos para revisiones sistemáticas y metanálisis de la extensión para revisiones de alcance (Prisma-ScR). Se consultarán las siguientes fuentes de información: Cumulative Index to Nursing Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Web of Science, Scopus, Índice Bibliográfico de Literatura Latinoamericana y del Caribe en Ciencias de la Salud, así como literatura gris: Biblioteca Digital Brasileña de Tesis y Disertaciones de la Coordinación de Perfeccionamiento de Personal de Nivel Superior, ProQuest Dissertations and Theses y Google Scholar. La revisión bibliográfica se realizará de febrero a mayo de 2025 por dos revisores independientes y ciegos de forma simultánea. La pregunta de investigación se desarrolló con base en el mnemotécnico PCC (Población, Concepto, Contexto), considerando: Mujeres en el período preoperatorio (Población); Calidad de vida (Concepto de Interés) y Cirugía de Histerectomía Ginecológica (Contexto). La pregunta planteada fue: “¿Qué evidencia científica se encuentra sobre cómo se afecta la Calidad de Vida en el periodo preoperatorio de la Histerectomía?” Se incluirán estudios con diferentes enfoques metodológicos, sin restricciones temporales y/o idiomáticas. Los resultados de la búsqueda se describirán utilizando el diagrama de flujo Elementos de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA). El protocolo para esta revisión fue registrado en la plataforma Open Science Framework (https://osf.io/fc26v/).

Palabras clave: Histerectomía; Calidad de Vida; Periodo Preoperatorio.

 

INTRODUCTION

 

According to the World Health Organization (WHO), Quality of Life is defined as: "an individual's perception of their position in life, within the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns." It is considered a comprehensive concept, as it incorporates the complex and dynamic nature of physical and psychological health, interdependence, social relationships, beliefs, and interaction with the environment. QoL is subjective and multifaceted, encompassing both positive and negative aspects (1).

 In this sense, understanding the impacts of surgical interventions on QoL is essential, as it directly influences the decision to undergo a procedure, especially regarding the excision of organs such as the uterus (2). Hysterectomy is a surgical procedure aimed at removing all or part of the uterine body to treat benign and malignant gynecological conditions, including leiomyomas, hemorrhages, and endometriosis (3). Globally, it represents the second most prevalent gynecological surgical procedure in women of reproductive age, second only to cesarean section (3,4).

 Previous studies indicate that complications affect QoL not only because it is a surgery, but also because of its representation of femininity and conception, a fact that dates back to the historical past of civilizations. However, the psychological impact on health can be significant. It is common for there to be withdrawal from social interactions and activities that were enjoyed in the period prior to surgical confirmation, leading to dissatisfaction with life satisfaction (5,6).

 Clinically, hysterectomy is performed through three approaches: abdominal, vaginal, and laparoscopic, or combinations of these (7). Although safe, it carries a risk of complications to anatomical structures, with higher rates in the first 30 days: infections, hemorrhage, urinary tract and/or intestinal injury, vaginal vault dehiscence, and thromboembolic disease (8). Therefore, it can be a difficult choice for women, given the common sexual and psychological changes that can trigger a significant risk of traumatic stress (9).

 In the preoperative period, women can express their perspectives, bringing to light aspects that can significantly contribute to improving their clinical condition. Therefore, given that nursing consultations are essential for a successful surgical outcome, the importance of this professional's role in biopsychosocial coping with the patient is reiterated (10).

 Therefore, understanding preoperative QOL after gynecological surgery is essential for promoting strategies aimed at improving postoperative outcomes. Adequate understanding of the impact of care and expectations during the surgical experience can contribute to increasing satisfaction levels. Satisfaction can positively influence overall well-being and perceived QOL, potentially reducing suffering and/or physical discomfort (11).

 Given the above, this study is justified by the relevance of the topic to the healthcare process of women undergoing hysterectomy. Given that it represents one of the most frequently performed procedures in gynecology, it is essential to investigate aspects related to QoL from the surgical confirmation stage onward, as it encompasses a complex period of intense transformation. This is because, in the preoperative setting, it is possible to identify that the patient is permeated by conditions that directly affect her adaptation to the new health context.

Primary studies on the impact of hysterectomy on QoL have been published; however, most research focuses on postoperative investigation. However, during this period, emotional and physical damage has already set in, hindering interventions associated with preoperative education and telemedicine, methods that have proven effective and satisfactory for improving the patient experience (12).

 A preliminary search of PROSPERO, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing Allied Health Literature (CINAHL), and the JBI Evidence Synthesis was conducted in January 2025 to identify current or ongoing scoping or systematic reviews on this topic. However, none were identified. Therefore, this scoping review will help understand the dimensions assessed by specific instruments on QoL, in addition to providing healthcare professionals with knowledge for preoperative planning that addresses biopsychosocial needs and prevents and identifies impairments in these aspects.

 From this perspective, the objective of the scoping review is to map the evidence available in the scientific literature on how Quality of Life is affected in the preoperative period after Hysterectomy.

 

METHODS

 

Study Type

 

This is a scoping review protocol, structured according to the methodological guidelines of the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis (13) and aligned with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) Checklist (14). The protocol for this review was registered on the Open Science Framework (OSF) platform and can be accessed at https://osf.io/fc26v/, ensuring the transparency, reproducibility, and rigor of the method.

 This scoping review will be based on the a priori protocol (15), respecting the following steps: 1) Development of the research question, linking it to the objective; 2) Definition of eligibility criteria; 3) Description of the search strategy in the information sources; 4) Description of the data extraction process; 5) Highlighting the analysis and presentation of the results; 6) Mapping the data; Collect, synthesize, and report the results obtained; 7) Conduct a qualitative thematic analysis; 8) Establish corrections between the findings, research question, and objectives, drawing conclusions; 9) Identify the implications of the study findings for practice and/or research.

 

Developing the Research Question

 

To guide the study, the research question was developed based on the mnemonic PCC (Population, Concept, Context) (13). The following were considered: Women in the preoperative period (Population); Quality of Life (Concept of Interest); and Gynecological Hysterectomy Surgery (Research Context). Based on the above, the question posed was: "What scientific evidence has been found on how Quality of Life is affected in the preoperative period after hysterectomy?"

 Eligibility Criteria

 

The scope of this review will include primary quantitative, qualitative, or mixed-methods studies conducted with adult patients (18 years or older) undergoing elective hysterectomy in the preoperative period. There will be no time or language restrictions for inclusion. The Brazilian Ministry of Health's definition of elective surgery (16) will be considered: "An elective surgical procedure is any care provided to a patient in a surgical setting, with an established diagnosis and indication for surgery to be performed in an outpatient/hospital health service with the possibility of prior scheduling, without urgency or emergency."

 Duplicate studies, editorials, letters to the editor, commentaries, opinion pieces by experts in the field, reflections, abstracts, and studies that do not answer the research question or are not aligned with the research objectives will be excluded.

 

Search Strategy

 

Initially, a preliminary search will be conducted in the CINAHL (EBSCOhost) and MEDLINE (PubMed) information sources to identify relevant studies that meet the objective of this scoping review, as recommended by the JBI (13). The purpose will be to analyze the words contained in the titles, abstracts, and index terms that describe the studies of interest, a crucial step in defining the search strategy. Subsequently, study selection will be based on the delimitation of controlled and uncontrolled descriptors, selected from the Health Sciences Descriptors (DeCs), Medical Subject Headings (MeSH), and Subject Headings, according to the specificities of each database.

 The following databases and bibliographic indexes will be consulted: Cumulative Index to Nursing Allied Health Literature (CINAHL) via EBSCO, Medical Literature Analysis and Retrieval System Online (MEDLINE) via the National Library of Medicine (PubMed), Web of Science Core Collection via Clarivate Analytics, SciVerse Scopus (SCOPUS) via Elsevier, and the Bibliographic Index of Latin American and Caribbean Literature in Health Sciences (LILACS) via the Virtual Health Library (VHL).

 Regarding gray literature, information will be searched in the Brazilian Digital Library of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CAPES), ProQuest Dissertations and Theses (ProQuest), and Google Scholar (first five pages) to retrieve relevant studies.

 To combine terms and refine the search, the Boolean operators OR and AND will be used (Table 1). Consultation of the platforms will take place through the Journals Portal of the Coordination for the Improvement of Higher Education Personnel (CAPES) via institutional access by the Federated Academic Community (CAFe) of the Federal University of Piauí (UFPI).

 

Table 1 - Search syntax for articles in information sources. Teresina, Piauí, Brazil, 2025.

Source of information

Search syntax

CINHAL via EBSCO

 

(MH "Preoperative Period" OR "Preoperative Period" OR "Preoperative Care") AND (MH "quality of life" OR "quality of life" OR MH "health quality of life") AND (MH Hysterectomy OR Hysterectomy)

MEDLINE via PubMed

 

(((((((("preoperative period"[MeSH Terms]) OR ("preoperative period"[All Fields])) OR ("period preoperative"[All Fields])) OR ("preoperative care" [MeSH Terms])) OR ("preoperative care"[All Fields])) OR (women health[MeSH Terms])) OR ("women health"[All Fields])) AND ((((("quality of life"[MeSH Terms]) OR ("quality of life"[All Fields])) OR ("health related quality of life"[All Fields])) OR ("hrqol"[All Fields])) OR ("life quality"[All Fields]))) AND (((((hysterectomy[MeSH Terms]) ) OR ("hysterectomy"[All Fields])) OR ("gynecologic surgical procedures"[MeSH Terms])) OR ("gynecologic surgical procedures"[All Fields]))

Web Of Science via Clarivate Analytics

 

((((ALL=("preoperative period")) AND ALL=("quality of life")) OR ALL=("health related quality of life")) AND ALL=(hysterectomy))

SCOPUS via Elsevier

 

TITLE-ABS-KEY ("Preoperative period" OR "Preoperative care" ) AND TITLE-ABS-KEY ( "Quality of life" OR "health related quality of life" ) AND TITLE-ABS-KEY ( hysterectomy)

LILACS via BVS

 

((mh:("Período Pré-Operatório")) OR ("Pré-Operatório") OR ("Cuidados Pré-operatórios") OR ("Saúde da Mulher") OR ("Saúde das Mulheres") OR ("Saúde Feminina") OR (feminino)) AND ((mh:("Qualidade de vida")) OR (satisfação) OR (bem-estar) OR ("Qualidade de vida relacionada à saúde") OR (hrqol) OR (qvrs) OR ("Inquéritos e Questionários")) AND ((mh:(histerectomia)) OR ("Cirurgia Ginecológica") OR (histerectom*) OR ("remoção do útero")) AND db:("LILACS")

Biblioteca Digital Brasileira de Teses e Dissertações

“Período pré-operatório” AND “Qualidade de vida" AND Histerectomia

PROQUEST Dissertations and Theses

(TS=(Preoperative) OR TS=("preoperative period") AND TS=("quality of life")) AND TS=(hysterectomy)

Google Acadêmico

 

("Preoperative Period" OR "Período pré-operatório") AND ("Quality of life" OR "Qualidade de vida") AND (Histerectomia OR Hysterectomy)

Source: Research Data, 2025.

 

It is important to reiterate that the full search strategy, as well as the complete database and results collected, will be available for analysis during the final scoping review, to ensure the transparency and integrity of the study.

 

Data Extraction

 

The literature search will be conducted simultaneously from February to May 2025 by two independent, blind reviewers. In the event of disagreements between the reviewers during the process, a meeting will be proposed to reach a consensus. If disagreements persist, the opinion of a third reviewer will be consulted after reading the material in full.

 After the searches, all references will be managed using Rayyan® software (17), a tool that assists in the initial screening of scientific articles developed by the Qatar Computing Research Institute (QCRI). The studies will be exported to the software using the Research Information Systems (RIS) file format obtained from each of the databases consulted.

 The application (17) will be given a command to remove duplicate studies, maintaining only one version of each article. The titles and abstracts will be analyzed by two independent reviewers, considering the inclusion and exclusion criteria previously established for this scoping review (Step 1).

 The reviewers will then read the articles in full to identify their relevance for inclusion in the scoping review (Step 2). The references for each article will also be analyzed at this stage and, if potentially relevant, will be retrieved and imported into Rayyan® software. The reasons for excluding studies that do not meet the eligibility criteria will be documented and presented in the final scoping review.

 The data from the scientific articles will be mapped by two independent reviewers using a data extraction form developed based on the JBI manual (13) and then tabulated in Microsoft Word 2016. The sample will be identified through coding, assigning the initial "E" and an ascending number to each study.

 

Two instruments will be used to collect information (Table 2 and Table 3). The first will gather information about the publication's identification (authors/year/title/country), objective, methodological aspects, main results, and level of evidence.

 

Table 2 - Data extraction form. Teresina, Piauí, Brazil, 2025.

Author(s)/

Year

Title

Country

Objective

Method

Main reasons

Level of evidence

Source: Prepared by the authors, 2025.

 

The second instrument will collect data related to the PCC mnemon, aiming to meet the study objective: population/sample size, age range, sociodemographic profile, instrument(s) used to assess QoL, and dimensions affected in the preoperative period following hysterectomy.

 

Table 3 - Data extraction form. Teresina, Piauí, Brazil, 2025.

 

Population/

Sample size

Age

Sociodemographic profile

Diagnosis(es) that led to the performance of the Hysterectomy

Instrument(s) used in assessing Quality of Life

Dimensions affected in the preoperative period after hysterectomy

Source: Prepared by the authors, 2025.

 

The forms will be pilot-tested to ensure reviewers' familiarity with the tool and data extraction procedures on a 20% sample of the studies selected for the sample. The collection instruments will be reviewed and may undergo modifications during data collection if additional variables need to be mapped. These modifications will be presented in the full scoping review report.

 It is important to note that the extraction of variables of interest from the selected studies will occur independently among the reviewers. The information will be confirmed by a third reviewer, whose doubts will be resolved through discussions and meetings.

 At the end of the searches, the level of inter-reviewer agreement will be calculated using the Kappa coefficient (18). It is worth noting that the lead author of the articles may be contacted to request incomplete or additional data, if necessary.

 

Evidence Analysis and Presentation of Results

 

The information obtained will be rigorously analyzed, discussed, and organized into tables to facilitate understanding, accompanied by a narrative summary characterizing the research. This scoping review will use the JBI's level of evidence classification to evaluate the selected scientific articles (19).

 Furthermore, correlations will be established between the findings, the research question, and objectives, resulting in conclusions. At the end of the study, researchers will identify any gaps identified and the implications of the study findings for practice and/or research, as directed by the scoping review methodological guidelines (15). Search results will be described using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart (20).

 

Ethical and Legal Aspects

 

Because this is a study that will use publicly available data, submission to and review of this scoping review by the Research Ethics Committee (REC) is not required. However, all references cited throughout this review will be duly cited, respecting copyright legislation.

 

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Funding and Acknowledgments

 

 This work was funded by the Coordination for the Improvement of Higher Education Personnel (CAPES) through a Master's scholarship (Process Number: 88887.953487/2024-00).

 

Authorship Criteria (Author Contributions)

 

Lara Beatriz de Sousa Coelho. 1. Substantially contributed to the conception and/or planning of the study; 2. Obtained, analyzed, and/or interpreted the data; 3. Written and/or critically reviewed and approved the final version of the published version.

 

Eugênio Barbosa de Melo Júnior. 1. Substantially contributed to the conception and/or planning of the study; 2. Obtained, analyzed, and/or interpreted the data; 3. Written and/or critically reviewed and approved the final version of the published version.

 

Maria Zélia de Araújo Madeira. 2. Obtained, analyzed, and/or interpreted the data; 3. Drafting and/or critical review and final approval of the published version.

 

Declaration of Conflict of Interest

 

Nothing to declare.

 

Scientific Editor: Ítalo Arão Pereira Ribeiro. Orcid: https://orcid.org/0000-0003-0778-1447

 

Rev Enferm Atual In Derme 2025;99(3): e025129                   

by Atribuição CCBY