Decision making and abortion methods

Introduction: This thesis investigates abortion service providers' adequacy to facilitate women's choices to have either a medical or surgical abortion. Both the medical and surgical methods of abortion are effective procedures to terminate unwanted pregnancies in early gestation. Provided there is no medical contraindication, women can make the choice about which method of abortion to have. The role of health professionals is to provide complete and accurate information that encourages women to make informed choices between treatment options. This thesis describes three studies which a) assess the adequacy of written information to support choices about abortion methods across service providers in England and Wales, b) describe the quality of verbal information provided by health professionals to women choosing to have an abortion type in routine consultations, and c) evaluate a leaflet designed to facilitate women's choices to have either a medical or surgical abortion. Methods: Two studies employ a cross-sectional survey design with qualitative and quantitative methods, the third a randomised controlled trial. The samples include: service provider's leaflets from across England and Wales (n=44); the content of doctors' consultations in a regional abortion service in Leeds (n=23); women undertaking abortions for unwanted pregnancies in a regional abortion service in Leeds (n=313). Measures assess the accuracy and quality of information provided, and the degree to which the leaflet facilitated women's decisions about abortion method. Results: The analysis of written and verbal information routinely provided by abortion service providers found that the procedures on having the abortion types were adequately described. However,information about the risks and benefits of each method were described less accurately and/or consistently. The findings from the trial indicate that a leaflet can enable women to make more informed decisions without increasing anxiety but does not impact on the type of abortion method chosen. Conclusions: Most information about types of abortion method routinely provided by abortion service providers is not sufficient to enable women to make informed choices. However, services can meet policy objectives on informed patient decision making with minimal resource implications as the decision aid leaflet enabled women to evaluate more information about the risks and benefits of the abortion methods in accord with their own beliefs