Quantity over quality-Findings from a systematic review and environmental scan of patient decision aids on early abortion methods.

Kyla Z Donnelly,Rachel Thompson,Glyn Elwyn

doi:10.1111/hex.12617

Kyla Z Donnelly, Rachel Thompson + Show 1 more

Open Access

https://doi.org/10.1111/hex.12617

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Abstract

BackgroundThe availability and effectiveness of decision aids (DAs) on early abortion methods remain unknown, despite their potential for supporting women's decision making.ObjectiveTo describe the availability, impact and quality of DAs on surgical and medical early abortion methods for women seeking induced abortion.Search strategyFor the systematic review, we searched MEDLINE, Cochrane Library, CINAHL, EMBASE and PsycINFO. For the environmental scan, we searched Google and App Stores and consulted key informants.Inclusion criteriaFor the systematic review, we included studies evaluating an early abortion method DA (any format and language) vs a comparison group on women's decision making. DAs must have met the Stacey et al (2014). Cochrane review definition of DAs. For the environmental scan, we included English DAs developed for the US context.Data extraction and synthesisWe extracted study and DA characteristics, assessed study quality using the Effective Practice and Organization of Care risk of bias tool and assessed DA quality using International Patient Decision Aid Standards (IPDAS).ResultsThe systematic review identified one study, which found that the DA group had higher knowledge and felt more informed. The evaluated DA met few IPDAS criteria. In contrast, the environmental scan identified 49 DAs created by non‐specialists. On average, these met 28% of IPDAS criteria for Content, 22% for Development and 0% for Effectiveness.ConclusionsResearch evaluating DAs on early abortion methods is lacking, and although many tools are accessible, they demonstrate suboptimal quality. Efforts to revise existing or develop new DAs, support patients to identify high‐quality DAs and facilitate non‐specialist developers' adoption of best practices for DA development are needed.

Highlights

As we have described previously,[1] women in the United States value receiving quality information[2,3,4] and support[5] when making decisions about early abortion.[6,7,8,9] The two recommended methods, surgical and medical abortion, are both highly effective, safe and acceptable, yet differ across several aspects.[10]
According to a recent national survey of abortion providers,[11] both methods are available in a majority of abortion facilities, and among those facilities that offer only the medical option, most are located in areas served by those that offer surgical abortion.[11]
The two objectives of this study were (i) to conduct a systematic review to identify, appraise and evaluate the impact of early abortion method decision aids described in the scientific literature, and (ii) to conduct an environmental scan of the grey literature to identify and appraise other early abortion method decision aids developed in the United States

Summary

Introduction

As we have described previously,[1] women in the United States value receiving quality information[2,3,4] and support[5] when making decisions about early abortion.[6,7,8,9] The two recommended methods, surgical and medical abortion, are both highly effective, safe and acceptable, yet differ across several aspects (eg duration, bleeding and cramping profile, where the abortion takes place, follow-up visit requirements).[10]. Despite the potential utility of a decision aid on early abortion methods, we lack knowledge on the availability, quality and impact of existing decision aids on this topic. The availability and effectiveness of decision aids (DAs) on early abortion methods remain unknown, despite their potential for supporting women’s decision making. Inclusion criteria: For the systematic review, we included studies evaluating an early abortion method DA (any format and language) vs a comparison group on women’s decision making. The environmental scan identified 49 DAs created by non-specialists. On average, these met 28% of IPDAS criteria for Content, 22% for Development and 0% for Effectiveness. Conclusions: Research evaluating DAs on early abortion methods is lacking, and many tools are accessible, they demonstrate suboptimal quality. Efforts to revise existing or develop new DAs, support patients to identify high-quality DAs and facilitate non-specialist developers’ adoption of best practices for DA development are needed

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