Abstract
Objectives
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.
Results
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.
Conclusions
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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Biography
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.
Biography
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.
Biography
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.
Biography
Rachel Thompson, PhD, is a senior research fellow at The University of Sydney with research interests in women's health.
Article info
Publication history
Published online: June 29, 2019
Accepted:
May 24,
2019
Received in revised form:
May 9,
2019
Received:
April 25,
2018
Footnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Kyla Z. Donnelly had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have completed the ICMJE uniform disclosure form and have no relationships or activities that could appear to have influenced the submitted work.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
