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1.
Womens Health Issues ; 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38658288

RESUMO

INTRODUCTION: Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients' interest in these models. METHODS: Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants. RESULTS: Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly. CONCLUSIONS: Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.

2.
Artigo em Inglês | MEDLINE | ID: mdl-38666706

RESUMO

INTRODUCTION: Quality abortion care must be person-centered. Although academic literature has focused on full-spectrum and abortion doulas supporting instrumentation abortion (also referred to as procedural abortion) clients, clients undergoing medication abortion remain understudied and may have unique needs. We aimed to understand United States (US) abortion support providers' perceptions of medication abortion clients' support needs by exploring which needs they address, which needs remain unmet, and how remote support provision might help address client needs. METHODOLOGY: Between April and October 2018, we conducted 60- to 90-min semi-structured, in-depth interviews by telephone with medication abortion support providers. The interviews focused on their experiences providing support to medication abortion clients in the US. We used a deductive thematic analysis approach. RESULTS: We interviewed 16 abortion support providers affiliated with nine US-based organizations. Six participants provided in-person support to medication abortion clients, five provided remote support, and five provided both remote and in-person support. Both in-person and remote providers described offering support that addressed clients' informational, emotional, physical, spiritual, and logistical needs. Through participant narratives, we identified interwoven benefits and challenges to remote support care provision. Participants highlighted that most medication abortion clients did not have a support provider. DISCUSSION: Participants revealed that abortion support providers, including remote support providers, can be a critical component of high-quality abortion care provision. More work is needed to ensure all abortion clients have access to support services as the abortion landscape in the US continues to evolve.

4.
Contraception ; 131: 110342, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38012964

RESUMO

OBJECTIVES: Understanding barriers to abortion care is particularly important post-Dobbs. However, many abortion access studies recruit from abortion-providing facilities, which overlook individuals who do not present for clinic-based care. To our knowledge, no studies have reviewed research recruitment strategies in the literature or considered how they might affect our knowledge of abortion barriers. We aimed to identify populations included and sampling methods used in studies of abortion barriers in the United States. STUDY DESIGN: We used a scoping review protocol to search five databases for articles examining US-based individuals' experiences accessing abortion. We included English-language articles published between January 2011 and February 2022. For included studies, we identified the sampling strategy and population recruited. RESULTS: Our search produced 2763 articles, of which 71 met inclusion criteria. Half of the included papers recruited participants at abortion-providing facilities (n = 35), while the remainder recruited from online sources (n = 14), other health clinics (n = 10), professional organizations (n = 8), abortion funds (n = 2), community organizations (n = 2), key informants (n = 2), and an abortion storytelling project (n = 1). Most articles (n = 61) reported information from people discussing their own abortions; the rest asked nonabortion seekers (e.g., physicians, genetic counselors, attorneys) about barriers to care. CONCLUSIONS: Studies of abortion barriers enroll participants from a range of venues, but the majority recruit people who obtained abortions, and half recruit from abortion clinics. IMPLICATIONS: As abortion access becomes constrained and criminalized in the post-Roe context, our findings indicate how investigators might recruit study participants from a variety of settings to fully understand the abortion seeking experience.


Assuntos
Aborto Induzido , Gravidez , Feminino , Estados Unidos , Humanos , Instituições de Assistência Ambulatorial , Acessibilidade aos Serviços de Saúde
5.
Contraception ; 131: 110327, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37979644

RESUMO

OBJECTIVES: We aimed to measure both stated and experimentally "revealed" abortion provision preferences among US people with capacity for pregnancy. STUDY DESIGN: In July 2022, we recruited US residents assigned female sex at birth and aged 18 to 55 years using Prolific, an online survey hosting platform. We asked participants what first-trimester abortion method and delivery model they would prefer. We also assessed abortion care preferences with a discrete choice experiment, which examined the relative importance of the following care attributes: method, distance, wait time for appointment, delivery model (telehealth vs in-clinic), and cost. RESULTS: More than half of the 887 respondents (59%) self-reported a slight (22%) or strong (37%) preference for medication compared to aspiration abortion; 11% stated no preference. Our discrete choice experiment found that cost and wait time had a greater effect on hypothetical decision-making than did method and delivery model (discrete choice experiment average importances = 44.3 and 23.2, respectively, compared to 15.9 and 8.2, respectively). Simulations indicated that holding other attributes constant, respondents preferred medication to aspiration abortion and telehealth to in-clinic care. CONCLUSIONS: This study, the first to examine abortion preferences in the United States, using a discrete choice experiment, demonstrates the importance of wait time and cost in abortion care decision-making. Our work indicates that for this population, factors related to health care financing and organization may matter more than clinical aspects of care. IMPLICATIONS: Although people in this study preferred medication to aspiration abortion and telehealth to in-clinic care, wait time and cost of care played a greater role in care decision-making. Focusing solely on clinical aspects of care (i.e., method, delivery model) may ignore other attributes of care that are particularly important for potential patients.


Assuntos
Aborto Espontâneo , Telemedicina , Gravidez , Recém-Nascido , Humanos , Feminino , Tomada de Decisões , Comportamento de Escolha , Preferência do Paciente , Inquéritos e Questionários
6.
Sex Reprod Health Matters ; 31(1): 2248742, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37728428

RESUMO

People seeking abortion may need or want emotional or informational support before, during, and after their abortion. Feeling supported and affirmed contributes to perceptions of quality care. The All-Options Talkline offers free, telephone-based, peer counselling to callers anywhere in the United States. This study aimed to explore the types of support received through the Talkline and the ways it supplemented other forms of support received by people who obtained an abortion. Between May 2021 and February 2022, we conducted 30 interviews via telephone or Zoom with callers recruited through the Talkline. We coded the interviews and conducted thematic analysis, focusing on themes related to gaps of support from family, friends, and healthcare professionals, as well as types of support received through the Talkline. We identified four key motivations for calling the Talkline, including the need for (1) decision-making support and validation, (2) a neutral perspective, (3) emotional support to discuss negative or complex feelings, and (4) information about the abortion process. Participants indicated that interactions with family, friends, and healthcare professionals ranged from unsupportive and negative, to substantially supportive. Access to the Talkline was particularly useful prior to clinical interactions and in the weeks or months after an abortion. We found that the All-Options Talkline provided person-centred, remote support for callers, filling gaps or supplementing support from one's community or healthcare professionals. Abortion support from non-medically trained support people contributes to high-quality abortion care, especially in a time of increasing abortion restrictions and use of remote abortion services.


Assuntos
Aborto Induzido , Feminino , Gravidez , Humanos , Emoções , Pessoal de Saúde , Motivação , Qualidade da Assistência à Saúde
7.
Palliat Support Care ; : 1-6, 2023 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-37249086

RESUMO

OBJECTIVES: To examine how an advance care planning (ACP) intervention based on structured conversations impacts the relationship between patients with advanced cancer and their nominated Personal Representatives (PRs). METHODS: Within the ACTION research project, a qualitative study was carried out in 4 countries (Italy, United Kingdom, the Netherlands, and Slovenia) to explore the lived experience of engagement with the ACTION Respecting Choices® ACP intervention from the perspectives of patients and their PRs. A phenomenological approach was undertaken. RESULTS: Our findings show that taking part in the ACTION ACP intervention provides a communicative space for patients and their PRs to share their understanding and concerns about the illness and its consequences. In some cases, this may strengthen relationships by realigning patients' and PRs' understanding and expectations and affirming their mutual commitment and support. SIGNIFICANCE OF RESULTS: The most significant consequence of the ACP process in our study was the deepening of mutual understanding and relationship between some patients and PRs and the enhancement of their sense of mutuality and connectedness in the present. However, being a relational intervention, ACP may raise some challenging and distressing issues. The interpersonal dynamics of the discussion require skilled and careful professional facilitation.

8.
Ann Epidemiol ; 76: 98-107, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36332754

RESUMO

PURPOSE: Quantify the misclassification of abortion accessibility resulting from calculations based on block groups, census tracts, ZCTAs, or counties versus census blocks. METHODS: We included 850 facilities from the 2018 ANSIRH Facility Database and Planned Parenthood website. Accessibility was the proportions of 18-44 year-old women living within a 30-, 60-, and 90-minute drive from an abortion-providing facility. We calculated accessibility using five different geographic units: census blocks, block groups, census tracts, ZCTAs, and counties. We estimated the potential magnitude of abortion accessibility misclassification resulting by calculating the difference between accessibility calculated using each geographic unit, respectively, for each drive time as compared to census blocks. RESULTS: In this analysis, counties, the largest geographic unit considered, underestimated national abortion accessibility compared with census blocks by up to 24.21 percentage points; while block group-, census tract, or ZCTA-based national estimates of abortion accessibility in the US resulted in small underestimates relative to estimates constructed using census blocks. CONCLUSIONS: Studies of population accessibility should use the smallest feasible geographic unit of analysis. While this study focused on abortion accessibility, our findings likely apply to other health services, particularly those with distributions like abortion care.


Assuntos
Censos , Acessibilidade aos Serviços de Saúde , Gravidez , Estados Unidos , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Bases de Dados Factuais
9.
Mhealth ; 8: 32, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36338311

RESUMO

Background: In the site-to-site telehealth for medication abortion model, patients visit a health center to meet with a remote clinician using telehealth technology. This model is safe, effective, and acceptable to patients and providers. The objective of this study was to document the experiences of patients and providers using telehealth for medication abortion in Planned Parenthood health centers across different geographical contexts in the United States. Methods: We conducted in-depth interviews with Planned Parenthood medication abortion patients who either met with a clinician at the clinic via telehealth or in-person about their experiences receiving care. We also interviewed Planned Parenthood staff members about their experiences implementing telehealth for medication abortion at their health center. Results: We interviewed 29 patients who received care at Planned Parenthood health centers in five states. Both telehealth and in-person patients described positive interactions with health center staff and clinicians. The vast majority of telehealth patients said that they felt comfortable speaking with the clinician over telehealth and had no trouble using the telehealth technology. We interviewed 12 providers, including clinicians and administrative staff, who worked in seven states. Providers largely thought that telehealth for medication abortion expanded access to medication abortion. Conclusions: Across different locations, our findings indicate that patients found telehealth for medication abortion services to be highly acceptable and providers found that telehealth services may help improve medication abortion access. As the use of telehealth for medication abortion expands, future research should include additional measures of quality to ensure that services are acceptable across different identities and experiences, including age, race, gender, and income level.

10.
Eur J Cancer Care (Engl) ; 31(6): e13719, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36168108

RESUMO

OBJECTIVE: Clinicians' fears of taking away patients' hope is one of the barriers to advance care planning (ACP). Research on how ACP supports hope is scarce. We have taken up the challenge to specify ways in which ACP conversations may potentially support hope. METHODS: In an international qualitative study, we explored ACP experiences of patients with advanced cancer and their personal representatives (PRs) within the cluster-randomised control ACTION trial. Using deductive analysis of data obtained in interviews following the ACP conversations, this substudy reports on a theme of hope. A latent thematic analysis was performed on segments of text relevant to answer the research question. RESULTS: Twenty patients with advanced cancer and 17 PRs from Italy, the Netherlands, Slovenia, and the United Kingdom were participating in post-ACP interviews. Three themes reflecting elements that provide grounds for hope were constructed. ACP potentially supports hope by being (I) a meaningful activity that embraces uncertainties and difficulties; (II) an action towards an aware and empowered position; (III) an act of mutual care anchored in commitments. CONCLUSION: Our findings on various potentially hope supporting elements of ACP conversations provide a constructive way of thinking about hope in relation to ACP that could inform practice.


Assuntos
Planejamento Antecipado de Cuidados , Neoplasias , Humanos , Pesquisa Qualitativa , Neoplasias/terapia , Comunicação , Reino Unido
11.
J Gen Intern Med ; 37(Suppl 3): 679-684, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36045191

RESUMO

BACKGROUND: The unintended pregnancy rate in the US military is higher than among civilians. While 42% of unintended pregnancies end in abortion among civilian women, there are no data on the prevalence of abortion in the military overall or by service branch. OBJECTIVE: This analysis was conducted to estimate unintended pregnancy rates and the percentage of unintended pregnancies that resulted in abortion among active-duty US Navy members aged 44 years or younger reporting female gender in 2016. DESIGN: Cross-sectional survey data from the 2016 Navy Pregnancy and Parenthood Survey, collected from August to November 2016. PARTICIPANTS: Our sample included 3,423 active-duty US Navy members aged 44 years or younger reporting female gender, generated from a stratified random sample of 38% of all active-duty Navy women in pay grades E2-E9 and O1-O5 in 2016; the survey had a 20% response rate for females. MAIN MEASURES: We calculated pregnancy and unintended pregnancy rates, the percentage of pregnancies that were unintended, and the percentage of unintended pregnancies resulting in birth and abortion in the prior fiscal year. KEY RESULTS: Overall, the self-reported unintended pregnancy rate was 52 per 1,000 participants and 38.1% of pregnancies were unintended. The adjusted unintended pregnancy rate accounting for abortion underreporting was 68 per 1,000 participants. Unintended pregnancy rates were highest among individuals who were younger (aged 18-24) and in enlisted pay grades, compared to their counterparts. Six percent reported their unintended pregnancy resulted in abortion. Six respondents reported becoming pregnant while deployed; none of these pregnancies resulted in abortion. CONCLUSIONS: In this first study to report on abortion prevalence among US servicemembers, we found the proportion of unintended pregnancies resulting in abortion among a sample of US Navy members in 2016 was much lower than civilians, yet unintended pregnancy rates were higher.


Assuntos
Aborto Induzido , Militares , Estudos Transversais , Feminino , Humanos , Gravidez , Gravidez não Planejada , Inquéritos e Questionários
12.
PLoS One ; 17(7): e0271919, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35901043

RESUMO

BACKGROUND: The ACTION trial evaluated the effect of a modified version of the Respecting Choices´ advance care planning programme in patients with advanced cancer in six European countries. For this purpose, an advance directive acceptable for all six ACTION countries to be used for documenting the wishes and preferences of patients and as a communication tool between patients, their caregivers and healthcare staff, was needed. AIM: To describe the development of a multinational cancer specific advance directive, the ´My Preferences form´, which was first based on the 2005 Wisconsin 'Physician Orders of Life Sustaining Treatment´ Form, to be used within the ACTION trial. METHODS: Framework analysis of all textual data produced by members of the international project team during the development of the ACTION advance directives (e.g. drafts, emails, meeting minutes…). SETTING/PARTICIPANTS: ACTION consortium members (N = 28) with input from clinicians from participating hospitals (N = 13) and ´facilitators´ (N = 8) who were going to deliver the intervention. RESULTS: Ten versions of the ACTION advance directive, the ´My Preferences form´, were developed and circulated within the ACTION consortium. Extensive modifications took place; removal, addition, modification of themes and modification of clinical to lay terminology. The result was a thematically comprehensive advance directive to be used as a communication tool across the six European countries within the ACTION trial. CONCLUSION: This article shows the complex task of developing an advance directive suitable for cancer patients from six European countries; a process which required the resolution of several cross cultural differences in law, ethics, philosophy and practice. Our hope is that this paper can contribute to a deeper conceptual understanding of advance directives, their role in supporting decision making among patients approaching the end of life and be an inspiration to others wishing to develop a disease-specific advance directive or a standardised multinational advance directive.


Assuntos
Planejamento Antecipado de Cuidados , Neoplasias , Médicos , Diretivas Antecipadas , Comunicação , Humanos , Neoplasias/terapia
13.
Am J Public Health ; 112(8): 1202-1211, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35830676

RESUMO

Objectives. To quantify the impact of telemedicine for medication abortion (TMAB) expansion or ban removal on abortion accessibility. Methods. We included 1091 facilities from the 2018 Advancing New Standards in Reproductive Health facility database and Planned Parenthood Web site, among which 241 did not offer abortion as sites for TMAB expansion. Accessibility was defined as the proportion of reproductive-aged women living within a 30-, 60-, or 90-minute drive time from an abortion-providing facility. We calculated accessibility differences between 3 scenarios: (1) facilities offering abortion in 2018 (reference), (2) the reference scenario in addition to all facilities in states without TMAB bans (TMAB expansion), and (3) all facilities (TMAB ban removal). We also stratified by state and urban-rural status. Results. In 2018, 65%, 81%, and 89% of women lived within a 30-, 60-, or 90-minute drive time from an abortion-providing facility, respectively. Expansion and ban removal expanded abortion accessibility relative to the current accessibility scenario (range: 1.25-5.66 percentage points). Women in rural blocks experienced greater increases in accessibility than those in urban blocks. Conclusions. TMAB program and policy changes could expand abortion accessibility to an additional 3.5 million reproductive-aged women. Public Health Implications. Our findings can inform where to invest resources to improve abortion accessibility. (Am J Public Health. 2022;112(8):1202-1211. https://doi.org/10.2105/AJPH.2022.306876).


Assuntos
Aborto Induzido , Telemedicina , Aborto Induzido/métodos , Adulto , Feminino , Instalações de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Políticas , Gravidez , Estados Unidos
14.
Contraception ; 115: 67-68, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35753405

RESUMO

OBJECTIVES: We assessed the safety and effectiveness of direct-to-patient telehealth provision of medication abortion in Australia. STUDY DESIGN: We included all medication abortions (January 2017-December 2018) from Marie Stopes Australia's patient management and adverse event reporting systems. We defined effectiveness as whether the patient had a continuing pregnancy, incomplete abortion, and/or subsequent vacuum aspiration or procedural abortion and safety as whether the patient experienced any adverse event. RESULTS: Direct-to-patient telehealth was more effective than in-clinic provision (97.2% vs 95.4%). The proportion of adverse events did not differ between groups. CONCLUSIONS: This direct-to-patient telehealth service is safe and effective.


Assuntos
Aborto Induzido , Telemedicina , Austrália , Estudos Transversais , Feminino , Humanos , Gravidez , Curetagem a Vácuo
15.
PLoS One ; 17(3): e0264748, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35239738

RESUMO

Most studies of abortion access have recruited participants from abortion clinics, thereby missing people for whom barriers to care were insurmountable. Consequently, research may underestimate the nature and scope of barriers that exist. We aimed to recruit participants who had considered, but failed to obtain, an abortion using three online platforms, and to evaluate the feasibility of collecting data on their abortion-seeking experiences in a multi-modal online study. In 2018, we recruited participants for this feasibility study from Facebook, Google Ads, and Reddit for an online survey about experiences seeking abortion care in the United States; we additionally conducted in-depth interviews among a subset of survey participants. We completed descriptive analyses of survey data, and thematic analyses of interview data. Recruitment results have been previously published. For the primary outcomes of this analysis, over one month, we succeeded in capturing data on abortion-seeking experiences from 66 individuals who were not currently pregnant and reported not having obtained an abortion, nor visited an abortion facility, despite feeling that abortion could have been the best option for a recent pregnancy. A subset of survey respondents (n = 14) completed in-depth interviews. Results highlighted multiple, reinforcing barriers to abortion care, including legal restrictions such as gestational limits and waiting periods that exacerbated financial and other burdens, logistical and informational barriers, as well as barriers to abortion care less frequently reported in the literature, such as a preference for medication abortion. These findings support the use of online recruitment to identify and survey an understudied population about their abortion-seeking experiences. Further, findings contribute to a more complete understanding of the full range of barriers to abortion care that people experience in the United States, and how these barriers intersect to not just delay, but to prevent people from obtaining abortion.


Assuntos
Aborto Induzido , Aborto Espontâneo , Mídias Sociais , Publicidade , Estudos de Viabilidade , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Gravidez , Ferramenta de Busca , Estados Unidos
16.
Palliat Med ; 36(4): 567-580, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35176924

RESUMO

BACKGROUND: The impact of living with palliative care needs arising from COPD disrupts an individual's existential situation. However, no comprehensive synthesis of existing research has been published to determine the presentation and impact of existential suffering. AIM: To provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. DESIGN: This is an integrative review paper, undertaken using the methodological approach developed by Soares and reported in accordance with PRISMA guidelines. Data analysis was undertaking using an integrated convergent synthesis approach. DATA SOURCES: Nine electronic databases were searched from April 2019 to December 2019. A second search was undertaken in January 2021 to identify recently published papers meeting the inclusion and exclusion criteria. No date restrictions were imposed. Only papers published in the English Language were considered for inclusion. Empirical research papers employing qualitative and/or quantitative methodologies and systematic literature reviews were included. Articles were accepted for inclusion if they discussed any component of existential suffering when living with COPD and palliative care needs. RESULTS: Thirty-five papers were included within this review comprising of seven systematic reviews, 10 quantitative studies and 18 qualitative studies. The following themes relating to existential suffering were found: Liminality, Lamented Life, Loss of Personal Liberty, Life meaning and Existential isolation. The absence of life meaning, and purpose was of most importance to participants. CONCLUSIONS: This review suggests existential suffering is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact. Further research is required to understand the essential components of an intervention to address existential suffering for this patient group, to ensure holistic palliative care delivery.


Assuntos
Cuidados Paliativos , Doença Pulmonar Obstrutiva Crônica , Humanos , Cuidados Paliativos/métodos , Doença Pulmonar Obstrutiva Crônica/terapia
17.
Artigo em Inglês | MEDLINE | ID: mdl-35177432

RESUMO

OBJECTIVES: Facilitated advance care planning (ACP) helps family carers' to be aware of patient preferences. It can improve family carers' involvement in decision making and their overall experiences at the end of life, as well as, reduce psychological stress. We investigated the effects of the ACTION Respecting Choices (RC) ACP intervention on the family carers' involvement in decision making in the last 3 months of the patients' life and on the family carers' psychological distress after 3 months of bereavement. METHODS: Over six European countries, a sample of 162 bereaved family carers returned a bereavement questionnaire. Involvement in decision making was measured with a single item of the Views of Informal Carers-Evaluation of Services Short Form questionnaire. Psychological distress was measured with the Impact of Event Scale (IES). RESULTS: No significant effect was found on family carers involvement in decision making in the last 3 months of the patients' life (95% CI 0.449 to 4.097). However, the probability of involvement in decision making was slightly higher in the intervention arm of the study (89.6% vs 86.7%; OR=1.357). Overall, no statistical difference was found between intervention and control group regarding the IES (M=34.1 (1.7) vs 31.8 (1.5); (95% CI -2.2 to 6.8)). CONCLUSION: The ACTION RC ACP intervention showed no significant effect on family carers' involvement in decision making or on subsequent psychological distress. More research is needed about (1) how family carers can be actively involved in ACP-conversations and (2) how to prepare family carers on their role in decision making. TRIAL REGISTRATION NUMBER: International Standard Randomised Controlled Trial Number ISRCTN17231.

18.
Nurs Open ; 9(2): 900-907, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34562307

RESUMO

AIM: This article describes the development and implementation of a virtual Consensus development project to address current challenges in adult nursing care in the UK. DESIGN: This is a Consensus Development Project (CDP). METHODS: The five stages of this CDP were: develop questions (informed by PPI representatives and a documentary review), generate evidence reviews, recruit and orient the lay panel, host Consensus seminars, and consult with panel members and stakeholders. RESULTS: To the best of our knowledge, a CDP has not previously been conducted in a UK nursing context, and this is the first of its kind to be hosted virtually. This article contributes a detailed outline of the Consensus development methodology and constructive commentary to support future Consensus development projects. Learning points include reflections on the impact of hosting this event virtually, the relationship between the project coordinator and chair, and the composition of the lay panel.


Assuntos
Pesquisadores , Consenso , Conferências de Consenso como Assunto , Humanos
19.
BMJ Sex Reprod Health ; 48(2): 103-109, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34531258

RESUMO

BACKGROUND: While abortion care is widely legal in Australia, access to care is often poor. Many Australians must travel long distances or interstate to access abortion care, while others face stigma when seeking care. Telehealth-at-home medical abortion is a potential solution to these challenges. In this study, we compared the experience of accessing an abortion via telehealth-at-home to accessing care in-clinic. METHODS: Over a 20-month period, we surveyed patients who received medical abortion services at Marie Stopes Australia via the telehealth-at-home service or in-clinic. We conducted bivariate analyses to assess differences in reported acceptability and accessibility by delivery model. RESULTS: In total, 389 patients were included in the study: 216 who received medical abortion services in-clinic and 173 through the telehealth-at-home service. Telehealth-at-home and in-clinic patients reported similarly high levels of acceptability: satisfaction with the service (82% vs 82%), provider interaction (93% vs 84%), and recommending the service to a friend (73% vs 72%). Only 1% of telehealth-at-home patients reported that they would have preferred to be in the same room as the provider. While median time between discovering the pregnancy to first contact with a clinic was similar between groups, median time from first contact to taking the first abortion medication was 7 days longer for telehealth-at-home patients versus in-clinic patients (14 days (IQR 9-21) vs 7 days (IQR 4-14); p<0.01). CONCLUSION: The telehealth-at-home medical abortion service has the potential to address some of the challenges with provision of abortion care in Australia.


Assuntos
Aborto Induzido , Telemedicina , Austrália , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Avaliação de Resultados da Assistência ao Paciente , Gravidez
20.
Int J Nurs Stud Adv ; 4: 100060, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38745639

RESUMO

Background: Sedation is used alongside mechanical ventilation for patients in intensive care units internationally; its use is complex and multifaceted. Existing evidence shows that the ways health care professionals use sedation significantly impacts patient outcomes, including how long someone spends on a ventilator, length of stay in intensive care and recovery. Objective: Our study aimed to systematically review and synthesize qualitative and quantitative evidence about how intensive care staff perceive sedation practices when looking after sedated and mechanically ventilated patients. Design: We performed a systematic integrated mixed-methods literature review collecting qualitative and quantitative studies according to inclusion and exclusion criteria. Studies were included if they were published from 2009 and focused on perceptions of staff working in general adult intensive care units and caring for mechanically ventilated patients. Settings: General adult intensive care units. Participants: Health care professionals working in adult intensive care units. Methods: Screening, data extraction and quality appraisal was undertaken by SV. Screening for inclusion and quality issues were reviewed by TR, TM and JS. The following databases: Embase, BNI, PubMed, Scopus, AMED, CINAHL, ASSIA, The Cochrane Library and Google Scholar. We used an assessment tool called the Mixed Methods Appraisal Tool. The studies were assessed and analysed by transforming the qualitative and quantitative data into 'text-in-context' statements. The statements were then synthesized using thematic analysis. Results: Eighteen studies were included from ten countries, fourteen quantitative and four qualitative. Three overarching themes were identified: 'Variation in Decision Making', 'Challenges in Decision Making' and 'Thinking Outside the Box'. Existing studies revealed that there is considerable variation in most aspects of perceived sedation practice. Staff face challenges with interprofessional collaboration and sedation practice, and there are barriers to using sedation protocols and light sedation. There is also evidence that there is a need for health care professionals to develop coping strategies to help them facilitate lighter sedation. Conclusions: A review of a decade of evidence shows that variation in decision making and challenges in decision making should be addressed to improve the care of the sedated and ventilated patient, and improve the caregiving experience for staff. Staff continue to require support with sedation practice, especially in light sedation. Research should now focus on how to help staff cope with looking after lightly sedated patients. In addition, future studies should focus on exploring sedation practices using qualitative methods as there is a dearth of qualitative evidence. Tweetable abstract: Staff perceive a range of complex challenges that explain some of the variability in sedation practice for the ventilated patient in ICU.

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