Decision making in complicated pregnancies

复杂妊娠中的决策

基本信息

批准号：
8719142
负责人：
Jennifer Kerns
金额：
$ 12.74万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-05 至 2015-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8719142
关键词：
Address Affect Belief California Characteristics Client satisfaction Cohort Studies Counseling Data Databases Decision Aid Decision Making Diagnosis Diagnostic Emotional Europe Fetus Frequencies Genetic Goals Grief reaction Health Services Improve Access Individual Interview Measures Mediation Medical Methods Michigan Modeling Operative Surgical Procedures Outcome Patient Preferences Patients Phase Population Pregnancy Pregnant Women Prenatal Diagnosis Prenatal care Procedures Process Prospective Studies Provider Psychological Impact Qualitative Methods Recovery Recruitment Activity Relative (related person)Reporting Retrospective Studies Screening Result Second Pregnancy Trimester Series Severities Site Symptoms Termination of pregnancy Testing Time Training Translating Universities Woman base coping emotional experience evidence base experience fetal improved instrument post-traumatic stress preference prenatal prospective psychological outcomes satisfaction screening

项目摘要

DESCRIPTION (provided by applicant): At least 3% of pregnancies are affected by a fetal anomaly.(1, 2) Screening for fetal anomalies in pregnancy has become a routine part of prenatal care (1 ) and most women choose to terminate a pregnancy if fetal abnormalities are detected. (3) While surgical and medical methods of second-trimester termination are both medically appropriate treatments,(8) they are very different experiences.(8-10) Medical termination involves full emotional participation as the patient experiences labor and delivery, while surgical termination allows for more emotional distancing. (10) Terminating a desired pregnancy is a vulnerable time for women and many report grief and posttraumatic stress symptoms more than a year afterwards.(17, 18) Women often rely heavily on advice from providers when terminating for a fetal anomaly;(18) but with no data regarding patient preferences for these two different methods, providers often recommend a method based on personal beliefs and practices rather than individual patient factors.(19) In fact, there is a strong provider bias toward recommending medical termination with the belief that viewing the fetus helps women grieve and recover.(11) Consequently, women may be inadvertently counseled toward a procedure that is contrary to their emotional needs, thus complicating their grief and delaying recovery. Although access to surgical termination is not uniform across the US, many women are accessing this method (20). The findings from this proposal, therefore, will have broad impact for women in the US who are negotiating the emotional experience of terminating a desired pregnancy. The specific aims of this proposal are as follows: Aim 1: To quantify the proportion of pregnant women diagnosed with a fetal anomaly who terminate their pregnancy and to quantify the proportion of these women who undergo surgical versus medical procedures. Aim 2: To modify and test instruments to measure decision satisfaction, grief and coping in women choosing surgical or medical termination for fetal anomaly. Aim 3: To describe predictors of decision satisfaction, grief and coping among women undergoing surgical or medical termination for fetal anomaly. The aims will be addressed in three phases. The first phase addresses Aim 1 with a retrospective cohort study of all Kaiser Permanente Northern California pregnant women diagnosed with a genetic or structural abnormality between 2000 and 2009. Quantitative analyses will be used to describe the proportion of women with an anomalous fetus who decide to continue versus terminate the pregnancy, and the proportion who undergo surgical versus medical termination. This study will offer important background information on the frequency of termination for fetal anomaly, the relative utilization of surgical versus medical methods and factors associated with undergoing each method. The second phase addresses Aim 2 through a series of qualitative interviews with women who have recently terminated an anomalous pregnancy. Interviews will be conducted one to three weeks and three months after the procedure. Subjects will be recruited from UCSF and University of Michigan, two sites where women have equal access to both methods. With the themes that emerge from the interviews, we aim to develop models for (1) how women define decision satisfaction, grief and coping, and (2) factors associated with decision satisfaction, grief and coping among women undergoing each method. Using those models and themes from the interviews, we will modify and test existing instruments of those outcomes for use in this population of women. The third phase is a pilot prospective study of women terminating an anomalous pregnancy to identify predictors of decision satisfaction, grief and coping using the modified instruments. The predictors associated with each method will then allow us to develop a decision aid after this proposal.

描述（由申请人提供）：至少 3% 的妊娠受到胎儿异常的影响。(1, 2) 妊娠期胎儿异常筛查已成为产前护理的常规部分 (1)，大多数女性选择终止妊娠如果发现胎儿异常。 (3) 虽然妊娠中期终止妊娠的手术和药物方法都是医学上适当的治疗方法，(8) 它们是非常不同的经历。(8-10) 药物终止妊娠需要患者在经历临产和分娩时充分的情感参与，而手术终止妊娠允许更多的情感距离。 (10) 终止妊娠对女性来说是一个脆弱的时期，许多人在一年多后报告出现悲伤和创伤后应激症状。(17, 18) 女性在因胎儿异常而终止妊娠时往往严重依赖医疗服务提供者的建议；(18)但由于没有关于患者对这两种不同方法的偏好的数据，提供者通常会根据个人信仰和实践而不是患者个体因素推荐一种方法。(19) 事实上，提供者对建议医疗终止存在强烈的偏见，因为他们相信：观看(11) 因此，妇女可能会无意中被建议进行与她们情感需求相反的手术，从而使她们的悲伤复杂化并延迟康复。尽管美国各地接受手术终止妊娠的情况并不统一，但许多妇女正在采用这种方法 (20)。因此，该提案的研究结果将对正在协商终止妊娠的情感体验的美国女性产生广泛影响。该提案的具体目标如下：目标 1：量化被诊断患有胎儿异常的孕妇终止妊娠的比例，并量化这些女性接受外科手术与医疗程序的比例。目标 2：修改和测试仪器，以衡量因胎儿异常而选择手术或药物终止妊娠的妇女的决策满意度、悲伤和应对方式。目标 3：描述因胎儿异常而接受手术或药物终止妊娠的妇女的决策满意度、悲伤和应对的预测因素。这些目标将分三个阶段实现。第一阶段通过对 2000 年至 2009 年间诊断出患有遗传或结构异常的所有 Kaiser Permanente 北加州孕妇进行回顾性队列研究来实现目标 1。定量分析将用于描述决定继续治疗的胎儿异常的女性比例与终止妊娠，以及接受手术与药物终止妊娠的比例。这项研究将提供关于胎儿异常终止的频率、手术与医疗方法的相对利用以及与每种方法相关的因素的重要背景信息。第二阶段通过对最近终止异常妊娠的妇女进行一系列定性访谈来实现目标 2。面试将在手术后一到三周和三个月内进行。受试者将从加州大学旧金山分校和密歇根大学招募，这两个地点的女性可以平等地使用这两种方法。根据访谈中出现的主题，我们的目标是开发模型：（1）女性如何定义决策满意度、悲伤和应对方式，以及（2）接受每种方法的女性中与决策满意度、悲伤和应对方式相关的因素。利用访谈中的这些模型和主题，我们将修改和测试现有的这些结果工具，以供该女性群体使用。第三阶段是对终止异常妊娠的妇女进行一项试点前瞻性研究，以使用改进的工具确定决策满意度、悲伤和应对的预测因素。然后，与每种方法相关的预测变量将允许我们在该提案之后开发决策辅助工具。