Developing and testing a decision support tool for women making tubal sterilization decisions.

开发和测试决策支持工具，帮助女性做出输卵管绝育决定。

基本信息

批准号：
9920197
负责人：
SONYA B. BORRERO
金额：
$ 70.32万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-14 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9920197
关键词：
Awareness California Clinical Coercion Color Comprehension Conflict (Psychology)Consensus Consent Consent Forms Contraceptive Usage Contraceptive methods Counseling Decision Aid Decision Making Ensure Female Funding Goals Health Health Personnel Informed Consent Institutes Interview Knowledge Logistics Low income Medicaid Methods Minority Nature Online Systems Operative Surgical Procedures Patients Perception Policies Population Postpartum Period Procedures Process Provider Public Health Randomized Randomized Controlled Trials Reading Regrets Regulation Reproductive Health Research Role Safety Site Standardization Sterilization Testing Time Tubal sterilization Unwanted pregnancy Vulnerable Populations Woman arm efficacy testing evidence base experience follow-up health equity high risk literacy novel policy implication preference primary outcome racial diversity racial minority reproductive reversible contraceptive satisfaction secondary outcome social support tools tool treatment as usual unintended pregnancy

项目摘要

Project Summary/ Abstract Female surgical sterilization is the second most commonly used contraceptive method in the US and is disproportionately used by low-income women and women of color. Whether the higher use of sterilization in these populations reflects inappropriate overutilization is unclear. On one hand, low-income and racial minority women frequently misunderstand the permanent nature of sterilization, are often unaware of reversible contraceptive alternatives, and commonly experience regret after the procedure– suggesting suboptimal decision making. On the other hand, there is evidence of substantial unmet demand for sterilization among low-income women, due to unique access barriers posed by Medicaid sterilization regulations, putting them at high risk for unintended pregnancy and the adverse health and social consequences associated with unintended pregnancy. Medicaid sterilization policy currently requires that all women requesting a federally-funded procedure complete a standardized consent form at least 30 days prior to sterilization. This policy was originally instituted in the 1970s to protect vulnerable women from coercive sterilization practices by attempting to ensure informed and voluntary consent. However, there is growing consensus that the policy is incapable of ensuring informed consent, and that the mandatory 30-waiting period impedes access to desired sterilization for many low-income women. The lack of a process that can ensure both informed consent and timely access for sterilization procedures hampers progress toward reproductive health equity for low-income women. The proposed project seeks to build and test a novel, web-based decision support tool to optimize low-income women's ability to make informed and value-concordant decisions about surgical sterilization. A decision support tool may be particularly useful in the context of sterilization decisions because this is a preference- sensitive decision with permanent implications and because there is a high level of misunderstanding about sterilization and limited awareness of alternative options among women who have undergone the surgery, indicating critical gaps in the quality of pre-sterilization counseling. Furthermore, patient-provider interactions may be complicated by a broader social and historical context in which poor and minority women's reproductive choices have not always been valued. Thus, the specific aims of this proposal are to qualitatively determine low-income women's decision support needs and preferences as well as providers' perspectives on the role of decision support around surgical sterilization (Aim 1); build a patient-directed, web-based decision aid to support women's sterilization decision making (Aim 2); and conduct a 3-site, randomized controlled trial to test the effect of the decision aid plus usual care compared to usual care alone on decision quality among 350 racially-diverse, low-income women requesting post-partum sterilization (Aim 3).

项目概要/摘要女性绝育手术是美国第二常用的避孕方法，低收入妇女和有色人种妇女使用的比例不高。是否使用绝育手术较高。这些人群不适当地反映了低收入和种族不明确的过度利用。少数族裔妇女经常误解绝育的永久性性质，往往不知道可逆的避孕替代方案，并且在手术后通常会感到后悔——建议另一方面，有证据表明，大量的需求未得到满足。由于医疗补助绝育造成独特的准入障碍，低收入妇女面临绝育法规，使她们面临意外怀孕以及不利健康和社会的高风险与意外怀孕相关的后果。医疗补助绝育政策目前要求所有申请联邦资助手术的妇女绝育前至少 30 天填写一份标准化同意书。于 20 世纪 70 年代制定，旨在保护弱势妇女免遭强制绝育做法，方法是：确保知情和自愿同意然而，越来越多的人认为该政策无法实现。确保知情同意，并且强制性的 30 等待期会妨碍获得所需的绝育手术对于许多低收入妇女来说，缺乏能够确保知情同意和及时获取的程序。因为绝育手术阻碍了低收入妇女在生殖健康公平方面取得进展。拟议的项目旨在构建和测试一种新颖的、基于网络的决策支持工具，以优化低收入群体妇女就绝育手术做出明智且符合价值观的决定的能力。支持工具在绝育决策中可能特别有用，因为这是一种偏好- 具有永久性影响的敏感决定，并且因为对这一问题存在高度误解绝育手术以及接受手术的妇女对替代选择的认识有限，此外，患者与提供者的互动表明绝育前咨询的质量存在严重差距。更广泛的社会和历史背景可能会使贫困和少数民族妇女的处境变得更加复杂。生殖选择并不总是受到重视，因此，该提案的具体目标是定性。确定低收入妇女的决策支持需求和偏好以及提供者的观点围绕手术绝育的决策支持的作用（目标 1）；建立以患者为导向的、基于网络的决策；援助支持妇女绝育决策（目标 2）并进行 3 点随机对照试验；在 350 名参与者中测试决策援助加常规护理与单独常规护理相比对决策质量的影响要求产后绝育的不同种族、低收入妇女（目标 3）。