Abortion| Volume 29, ISSUE 5, P414-423, September 2019

Promoting or Undermining Quality Decision Making? A Qualitative Content Analysis of Patient Decision Aids Comparing Surgical and Medication Abortion



      To understand, describe, and compare the content of patient decision aids on surgical and medication abortion, including 1) attributes used to describe each method, 2) approaches to clarify patients' values, 3) language used to describe each method, and 4) language used to frame women's decision-making role.

      Study Design

      We analyzed 49 decision aids identified through a previous systematic review and environmental scan. We used summative content analysis for objectives 1 and 2 and directed content analysis for objectives 3 and 4.


      We identified 37 method attributes. Overall, the attributes privileged medical over practical and emotional information. One decision aid included an explicit values clarification approach, and others included implicit approaches, which varied in length, information consistency, and organization. We identified four themes—information consistency, subjective claims, emotive or ambiguous descriptions, and medication abortion as not a real abortion—related to the methods' descriptions. We identified three themes—agency in choice, unclear emphasis on women's preferences, and endorsement of clinic services—related to women's decision-making role. Of the nine tools that listed factors influencing women's decision making, patient preferences was often listed last.


      Early abortion method decision aids presented a broad range of information and typically framed the method choice as the woman's. However, their emphasis on medical attributes, use of inconsistent information, and, at times, biased presentation of methods may undermine quality decision making. We recommend adapting an existing decision aid or designing a novel tool based on the content and language that women find most acceptable.
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      Kyla Z. Donnelly, MPH, PhD, is a postdoctoral research fellow at The Dartmouth Centers for Health and Aging with research interests in women's health.


      Glyn Elwyn, MB BCH, MSc, PhD, FRCGP, is a professor at The Dartmouth Institute for Health Policy and Clinical Practice with research interests in shared decision making.


      Regan Theiler, MD, PhD, is a senior associate consultant in the department of obstetrics and gynecology at the Mayo Clinic with research interests in women's health.


      Rachel Thompson, PhD, is a senior research fellow at The University of Sydney with research interests in women's health.