Consent for trainee participation in abortion care: A qualitative study of patient experiences and preferences in the United States

Abstract

ObjectivesAbortion training for clinicians is crucial to ensure patients’ future access to full-spectrum reproductive healthcare. Given the complex sociopolitical context of abortion, consent to allow a trainee’s involvement in abortion care requires careful attention to avoid harm to patients while also ensuring adequate clinician training for the future provision of care. In order to inform the development of patient-centered recommendations, we assessed patient experiences and preferences around consent for trainee participation during abortion care. Study designWe interviewed participants who received abortion care at sites with medical trainees in the United States. We conducted interviews via zoom (video-off) between August 2021 and January 2022. We audio-recorded and transcribed the interviews. We coded transcripts using NVivo software and analyzed inductively using thematic analysis. ResultsTwenty-four (n = 24) participants reflected a diverse range of sociodemographics as well as location of abortion service. Some reported experiences of coercion related to trainee involvement, ranging from subtle to overt. Participants preferred consent for trainee involvement in abortion care be a process outside the procedure room, while clothed, without the trainer or trainee present to allow for time to consider options without pressure to say yes. ConclusionsPatient-centered approaches to seeking consent for trainee involvement in abortion care must reduce potential for coercion. A standardized consent before the procedure room by a trained staff member without the trainer or trainee present can help prioritize patient autonomy. Understanding care team member roles and upholding confidentiality and privacy are paramount to patients feeling safe with trainees present. ImplicationsOur finding that patients experience varying levels of coercion to allow trainee participation in their abortion care highlights the dire need for patient-centered systemic changes—such as ensuring that consent take place outside the procedure room in a scripted fashion at eye level, while patients are clothed, and without trainers/trainees present—to maintain patient autonomy.