Interventions to Improve the informed consent process and perioperative education for women undergoing hysterectomy for benign indications: A systematic review.

OBJECTIVE: To systematically review interventions designed to improve the informed consent process and perioperative education for women undergoing hysterectomy for benign indications. DATA SOURCES: PubMed, Embase, CINAHL, and PsycINFO were searched from inception to February 2026. METHODS OF STUDY SELECTION: We included comparative studies evaluating interventions intended to improve perioperative counseling for women undergoing benign hysterectomy. Eligible studies reported consent- or knowledge-related, perioperative patient-reported, healthcare utilization, or legal outcomes. Citations were independently screened in duplicate; data extraction and risk-of-bias assessment were performed in duplicate, with reconciliation. TABULATION, INTEGRATION, AND RESULTS: Members of the Society of Gynecologic Surgeons Systematic Review Group screened 17,831 abstracts and identified 23 eligible studies reported in 24 articles. Risk-of-bias ranged from low to high. Three studies comparing audiovisual counseling (AVC) with standard verbal counseling (SVC) showed improved knowledge immediately after counseling and on the day of surgery, although gains were not consistently sustained. Two studies comparing AVC with written information (WI) found no consistent improvement in knowledge, satisfaction, anxiety, or postoperative outcomes, except shorter time to passage of flatus with AVC. Three studies comparing WI with SVC found no differences in anxiety, satisfaction, pain, recovery, or healthcare utilization. Two studies comparing enhanced recovery after surgery protocols with SVC reported inconsistent effects on satisfaction, postoperative well-being, and healthcare utilization. Twelve studies comparing enhanced counseling with SVC showed selected improvements in anxiety, depression, satisfaction, and well-being, but not preparedness, pain, analgesic use, length of stay, or unplanned postoperative encounters. One study evaluating cognitive reappraisal techniques added to WI found improved satisfaction without differences in anxiety, pain, or analgesic use. CONCLUSION: Interventions to improve the informed consent process and perioperative education for women undergoing benign hysterectomy most consistently improved short-term patient knowledge with AVC. Enhanced counseling showed selected benefits for anxiety, depression, satisfaction, and well-being. Evidence for improvement in pain, recovery, or healthcare utilization was limited.