'The Biggest Problem With Access': Provider Reports of the Effects of Wisconsin 2011 Act 217 Medication Abortion Legislation.

BACKGROUND: Abortion legislation in the United States determines people's access to services, including the abortion modality of their choice. In 2012, Wisconsin legislators passed Act 217, banning telemedicine for medication abortion and requiring the same physician to be physically present when patients signed state-mandated abortion consent forms and to administer abortion medications over 24 hours later. OBJECTIVE: No research documented real-time outcomes of 2011 Act 217 in Wisconsin; this study documents providers' descriptions of the effects of Wisconsin abortion regulations on providers, patients, and abortion care in the state. METHODS: We interviewed 22 Wisconsin abortion care providers (18 physicians and 4 staff members) about how Act 217 affected abortion provision. We coded transcripts using a combined deductive and inductive approach, then identified themes about how this legislation affects patients and providers. RESULTS: Providers interviewed universally reported that Act 217 negatively affected abortion care, with the same-physician requirement especially increasing risk to patients and demoralizing providers. Interviewees emphasized the lack of medical need for this legislation and explained that Act 217 and the previously enacted 24-hour waiting period worked synergistically to decrease access to medication abortion, disproportionately affecting rural and low-income Wisconsinites. Finally, providers felt Wisconsin's legislative ban on telemedicine medication abortion should be lifted. CONCLUSION: Wisconsin abortion providers interviewed underscored how Act 217, alongside previous regulations, limited medication abortion access in the state. This evidence helps build a case for the harmful effects of non-evidence-based abortion restrictions, which is crucial considering recent deferral to state law after the fall of Roe v Wade in 2022.

A Quantitative Study of Triggered Palliative Care Consultation for Hospitalized Patients With Advanced Cancer.

CONTEXT: Unplanned cancer-related hospital admissions often herald entry into the final phase of life. Hospitalized patients with advanced cancer have a high symptom burden and a short life expectancy, which may warrant palliative care intervention. OBJECTIVES: To identify the impact of implementing triggered palliative care consultation (TPCC) as part of standard care for patients admitted to the solid-tumor oncology service with advanced cancer. METHODS: We conducted a prospective, sequential, three-cohort study to evaluate TPCC feasibility and impact using patient-reported outcomes, electronic medical records to identify resource utilization, and surveys of oncologists' perspectives on TPCC. RESULTS: Sixty-five patients were evaluated before TPCC implementation (Cohort 1). Seventy patients (Cohort 2) were evaluated after initiation of TPCC, and 68 patients (Cohort 3) were evaluated after modifications based on implementation barriers identified in Cohort 2. The percentage of patients correctly identifying their cancer as incurable increased from 65% in Cohort 1 to 94% in Cohorts 2 and 3. TPCC had minimal impact on hospice utilization, cost of care, survival, patient-reported symptoms, and patient satisfaction, likely because of the limited nature of the intervention. Implementation was challenging, with only 60% of patients in Cohort 2 and 62% in Cohort 3 receiving TPCC. Overall, the intervention was viewed favorably by 74% of oncologists. CONCLUSION: Although TPCC was viewed favorably, implementation was logistically challenging because of short stays, high-acuity symptoms, and individual provider resistance. TPCC improved patients' understanding of their cancer. This population demonstrates high palliative care needs, warranting further research into how best to deliver care.