Quantity over quality—Findings from a systematic review and environmental scan of patient decision aids on early abortion methods

Abstract

BackgroundThe availability and effectiveness of decision aids (DAs) on early abortion methods remain unknown, despite their potential for supporting women's decision making.ObjectiveTo describe the availability, impact and quality of DAs on surgical and medical early abortion methods for women seeking induced abortion.Search strategyFor the systematic review, we searched MEDLINE, Cochrane Library, CINAHL, EMBASE and PsycINFO. For the environmental scan, we searched Google and App Stores and consulted key informants.Inclusion criteriaFor the systematic review, we included studies evaluating an early abortion method DA (any format and language) vs a comparison group on women's decision making. DAs must have met the Stacey et al (2014). Cochrane review definition of DAs. For the environmental scan, we included English DAs developed for the US context.Data extraction and synthesisWe extracted study and DA characteristics, assessed study quality using the Effective Practice and Organization of Care risk of bias tool and assessed DA quality using International Patient Decision Aid Standards (IPDAS).ResultsThe systematic review identified one study, which found that the DA group had higher knowledge and felt more informed. The evaluated DA met few IPDAS criteria. In contrast, the environmental scan identified 49 DAs created by non‐specialists. On average, these met 28% of IPDAS criteria for Content, 22% for Development and 0% for Effectiveness.ConclusionsResearch evaluating DAs on early abortion methods is lacking, and although many tools are accessible, they demonstrate suboptimal quality. Efforts to revise existing or develop new DAs, support patients to identify high‐quality DAs and facilitate non‐specialist developers' adoption of best practices for DA development are needed.

Online Decision Aids for Knee Osteoarthritis and Low Back Pain: An Environmental Scan and Evaluation

“…Compared to a similar study on decision aids for early abortion methods, 30 knee osteoarthritis and low back pain management decision aids fare better on qualification criteria, but many did not certify as a decision aid. This means that they provided information that was biased toward one management option over another.…”

“…According to IPDASi, sources of bias include not presenting positive and negative features with equal detail, not providing citations to evidence, not providing a publication date, not providing information about update policy, not providing information about the level of uncertainty, and not providing information about the funding source used to develop the decision aid. Moreover, other quality items scored poorly in the current study, which mirrored the study on early abortion methods 30 and a study on diabetes medication decision aids. 31 The quality items appear to be consistently poor, and developers would benefit from being transparent about the process used to develop these online decision aids (e.g., field testing with users, the evidence base used) as well as providing multiple presentations of numerical data in line with best practice.…”

Incidence Rate of Abortion and its Relationship with Sociodemographic Characteristics and Reproductive History among Women at Maternal and Pediatric Hospital in AL Diwaniyah City

“…Both surgical and medical abortion are highly efficient, safe and appropriate, but vary in different ways, such as length, bleeding and cramping (9) . We were unable to determine the exact gestation week of each abortion, which is known to be a strong predictor of complication risk (10) .…”

A Pregnancy Decision-Making Model: Psychological, Relational, and Cultural Factors Affecting Unintended Pregnancy

“…First, while the PDMM could be useful to reference in discussions with pregnant people in clinical or healthcare settings, it is not designed to be a decision-making tool. Whereas decisional tools/aids often incorporate factual information about pregnancy options and are written specifically to be used by pregnant people, the PDMM does not meet these or other specified criteria (Donnelly et al, 2018). Furthermore, and more importantly, the PDMM is designed from a reproductive justice framework and therefore should never be used in efforts to coerce pregnant people or otherwise limit their autonomy, agency, or access in pregnancy decision-making.…”