PMID- 27824749
DCOM- 20170614
LR  - 20180312
IS  - 1873-233X (Electronic)
IS  - 0029-7844 (Linking)
VI  - 128
IP  - 6
DP  - 2016 Dec
TI  - Treatment Decisions at the Time of Miscarriage Diagnosis.
PG  - 1347-1356
AB  - OBJECTIVE: To describe the factors patients and physicians prioritize during
      first-trimester miscarriage management and assess what drives satisfaction with
      care. METHODS: We conducted a mixed-methods study of clinically stable women
      seeking surgical, medical, or expectant miscarriage treatment. Women with
      first-trimester fetal demise or anembryonic gestation (N=55) completed
      demographic and psychosocial surveys. Using purposive sampling, 45 (82%)
      completed in-depth interviews. Fifteen obstetricians were interviewed.
      Participants described factors that informed their counseling (physicians) or
      decision-making (patients). Content analysis used an integrated approach with
      inductively and deductively derived codes. Patient-derived themes were stratified
      by treatment choice. Associations between variables and treatment choices were
      analyzed. RESULTS: Thirty-four women (62%) received surgical management, 19 (35%)
      received medical, and two (4%) received expectant. Physicians expected that women
      with prior pregnancies have strong management preferences, and indeed,
      multigravid patients were less likely to change their initial treatment choice
      after counseling than primigravid patients (12% compared with 42%, odds ratio
      [OR] 0.18, 95% confidence interval [CI] 0.04-0.81, P=.03). Physicians favored
      patient-centered decisions and patients chose the treatment that they thought
      would least affect other responsibilities. Those ultimately receiving surgical
      management had a higher monthly income (adjusted OR 1.30, 95% CI 1.04-1.63,
      P=.023) and more social support (adjusted OR 2.45, 95% CI 1.07-5.61, P=.035) than
      the medical group. The surgical group cited loss acceptance, a favorable
      perception of surgery, and a desire to expedite the miscarriage as decisive
      factors. The medical group endorsed control over, and timed completion of, the
      miscarriage in a more intimate setting, an aversion to surgery or anesthesia, and
      a perception of improved fertility preservation as decisive factors. Regardless
      of treatment choice, satisfaction with treatment was linked to a supportive
      clinical team and expeditious resolution. CONCLUSION: Prior pregnancy
      experiences, obligations, and sociodemographic factors influence miscarriage
      management decision-making. Structured counseling, especially for primigravid
      patients, could improve both the physician and the patient experience with
      miscarriage care.
FAU - Schreiber, Courtney A
AU  - Schreiber CA
AD  - Penn Family Planning and Pregnancy Loss Center, Department of Obstetrics and
      Gynecology, the Center for Clinical Epidemiology and Biostatistics, Department of
      Biostatistics and Epidemiology, and the Department of Family Medicine & Community
      Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
FAU - Chavez, Veronica
AU  - Chavez V
FAU - Whittaker, Paul G
AU  - Whittaker PG
FAU - Ratcliffe, Sarah J
AU  - Ratcliffe SJ
FAU - Easley, Ebony
AU  - Easley E
FAU - Barg, Frances K
AU  - Barg FK
LA  - eng
GR  - R01 HD071920/HD/NICHD NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
RN  - 0 (Abortifacient Agents)
SB  - IM
MH  - Abortifacient Agents/therapeutic use
MH  - Abortion, Spontaneous/diagnosis/*psychology/*therapy
MH  - Abortion, Therapeutic
MH  - Adolescent
MH  - Adult
MH  - *Choice Behavior
MH  - Directive Counseling/*methods
MH  - Female
MH  - Gravidity
MH  - Humans
MH  - Income
MH  - Interviews as Topic
MH  - Male
MH  - Middle Aged
MH  - *Patient Participation
MH  - *Patient Satisfaction
MH  - Practice Patterns, Physicians'
MH  - Pregnancy
MH  - Pregnancy Trimester, First
MH  - Social Support
MH  - Surveys and Questionnaires
MH  - Watchful Waiting
MH  - Young Adult
PMC - PMC5121058
MID - NIHMS817466
EDAT- 2016/11/09 06:00
MHDA- 2017/06/15 06:00
CRDT- 2016/11/09 06:00
PHST- 2016/11/09 06:00 [pubmed]
PHST- 2017/06/15 06:00 [medline]
PHST- 2016/11/09 06:00 [entrez]
AID - 10.1097/AOG.0000000000001753 [doi]
PST - ppublish
SO  - Obstet Gynecol. 2016 Dec;128(6):1347-1356. doi: 10.1097/AOG.0000000000001753.