Patient Education and Emotional Support Practices in Abortion Care Facilities in the United States

Gould, Heather; Perrucci, Alissa; Barar, Rana; Sinkford, Danielle; Foster, Diana Greene

doi:10.1016/j.whi.2012.04.003

Cited by 54 publications

(47 citation statements)

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“…Evaluating how certain a woman is about her decision to obtain an abortion is also an important component of abortion care [7]. However, unlike other health care decisions, many states enforce laws whose stated purpose is to protect women seeking abortion from making an unconsidered decision [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Measuring decisional certainty among women seeking abortion

et al. 2017

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STRUCTURED ABSTRACT ObjectiveEvaluating decisional certainty is an important component of medical care, including pre-abortion care.However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy. MethodsEligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews three weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at followup. ResultsFive hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=0.93 and 0.72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses. ConclusionThe DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care.Comparing scores on the DCS in this population to other studies of decision-making suggests that the level of uncertainty in abortion decision-making is comparable to or lower than other health decisions. ImplicationsThe high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling, and ultrasound viewing.

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Section: Introductionmentioning

confidence: 99%

“…Findings may aid providers in their pre-abortion counseling efforts [7] and can be useful in understanding the magnitude of decisional uncertainty among women seeking abortion as compared to other health decisions. …”

Section: Introductionmentioning

confidence: 99%

Measuring decisional certainty among women seeking abortion

et al. 2017

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“…As the required information visit increased costs of the abortion by 10% for this low income population and women reported multiple hardships associated with having to make two visits , a patient-centered approach that involves assessing certainty among women who present for abortion care and encouraging women who are uncertain about their decision to take more time and, if they decide to, come back another day for the procedure seems more appropriate than a blunt "one-size-fits-all" policy instrument that appears unnecessary for the overwhelming majority of abortion patients at these facilities. Such a patient-centered approach is a common part of abortion care among many providers (Foster, Gould, Taylor, et al, 2012;Gould, Perrucci, Barar, Sinkford, & Foster, 2012).…”

Section: Discussionmentioning

confidence: 99%

Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study

Roberts

Belusa

Turok

et al. 2017

Women's Health Issues

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Purpose: This paper examines how Utah's 72-hour waiting period and two-visit requirement influence women's certainty about their decision to have an abortion.Procedures: This study uses data from a prospective cohort study of 500 women who presented at an abortion information visit at four Utah family planning facilities. At the information visit, participants completed a baseline survey; three weeks later, they completed telephone interviews that assessed their pregnancy outcome, change in certainty, and an open-ended question about factors affecting changes in certainty.Main findings: Two-thirds (63%) reported no change in certainty due to the information visit and three-fourths (74%) reported no change in certainty due to the waiting period. Changes in certainty were primarily in the direction of increased certainty, with more than five times more women reporting an increase (29%) than a decrease (5%) in certainty due to the visit and two times more women reporting an increase (17%) than a decrease (8%) due to waiting. Changes in certainty were concentrated among the minority (8%) who were conflicted about their decision at baseline. Decreases in certainty due to waiting were concentrated among those who became less certain due to the visit. Learning about the procedure, meeting staff, and discovering that the facility was a safe medical environment were main contributors to increased certainty. Conclusion:As changes in certainty were concentrated among the small minority who were conflicted at the information visit and occurred due to the information visit, a universal waiting period does not appear appropriate.

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“…Owing to targeted state legislation that drains clinic budgets by forcing compliance with regulations beyond what is needed for patient health and safety [32,33], many abortion clinics must meet patient need in minimal time. In turn, clinics cut services such as in-depth counseling, which provides space for patients to process their values and preferences related to abortion [36]. Furthermore, in-depth counseling can enhance quality of and access to care when it identifies structural barriers to health outcomes (for example, difficulties travelling to follow-up appointments among undocumented persons due to police checkpoints) [36].…”

Section: Applying Structural Competency To Reproductive Healthmentioning

confidence: 99%

“…In turn, clinics cut services such as in-depth counseling, which provides space for patients to process their values and preferences related to abortion [36]. Furthermore, in-depth counseling can enhance quality of and access to care when it identifies structural barriers to health outcomes (for example, difficulties travelling to follow-up appointments among undocumented persons due to police checkpoints) [36]. A structurally competent approach to abortion care, incorporated into education and training curricula, would provide health care professionals with a framework to understand and analyze the social and political conditions that constrain the types of care available and influence clinical outcomes.…”

Section: Applying Structural Competency To Reproductive Healthmentioning

confidence: 99%

Structural Competency and Reproductive Health

2018

AMA Journal of Ethics

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Reproductive health disparities-particularly those experienced by racial and ethnic minority groups-are considered a persistent public health issue in the United States. Frameworks that focus on social determinants of health seek to identify the forces producing these disparities, particularly social conditions that create vulnerability to premature death and disease. Such frameworks pose challenges to health care provision, as structural factors can seem immutable to health care professionals trained to treat individual patients. Here, we discuss the links between reproductive health disparities and social determinants of health. We then apply to reproductive health care the structural competency framework, developed by physician-scholars to encourage health care professionals to address health disparities by analyzing and intervening upon sociopolitical forces.

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Patient Education and Emotional Support Practices in Abortion Care Facilities in the United States

Cited by 54 publications

References 4 publications

Measuring decisional certainty among women seeking abortion

Measuring decisional certainty among women seeking abortion

Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study

Structural Competency and Reproductive Health

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