Article
Options for management of early pregnancy loss: user’s decision depending on subjective psychological distress
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Authors
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Mirjam Peters
- University of Applied Sciences (Hochschule für Gesundheit), Department of Applied Health Sciences, Bochum, Germany
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Charalabos-Markos Dintsios
- Heinrich Heine University Dusseldorf, Institute for Health Services Research and Health Economics, Duesseldorf, Germany
| Published: | February 13, 2018 |
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Outline
Text
Background: Internationally, pregnant women with early pregnancy loss (EPF) may choose between the expectant, medical and surgical approach [1], [2]. Presumably, in Germany the surgical treatment is solely being offered in most cases of early pregnancy loss [3]. But what significance has choice for women with early pregnancy loss and which criteria are important in choosing care for women to be able to make an informed decision?
Aim/Question: Which are the preferences of women in management of early pregnancy loss in Germany and which performance aspects of supply options are relevant for women?
Methods: (1) At first a meta-analysis regarding benefits and harms of the three care options has been conducted. (2) With a systematic literature analysis of quantitative and qualitative surveys on preferences in early pregnancy loss potentially relevant performance criteria has been extracted. (3) Their transferability to Germany has been tested by one focus group interview. (4) Using the Analytic Hierarchy Process (AHP), weighting of the previously extracted performance criteria of the three supply options has been performed via telephone interviews (n=37). The APH besides of the Conjoint Analysis (CA) is one of two Multi Criteria Decision Analysis Methods (MCDA), which the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG) has tested for measuring patient preferences. It gives stable results even for small samples [4].
Results: From the bio-medical perspective, the meta-analysis gives no reason to prefer one of the three care options. Twelve relevant criteria regarding women’s decision making for a care option could be identified and weighted.
The quality criteria Consistency Ratio (CR) showed acceptable results. Subgroup analysis showed greater differences in preferences analysed regarding the stated requested option than analysed regarding their supply experiences. The interpretation of the quantitative evaluation has been supported by a qualitative survey.
Relevance: This contribution is the first quantitative evaluation of preferences regarding care options for women with early pregnancy loss taking into account psychological performance criteria. It is the first in Germany and also the first using AHP. The results could be used for involvement of preferences in provided information and in choosing which supply alternatives should be offered.
Analyses built on one another by means of qualitative and quantitative preference measuring instruments seem to work well to present affected persons’ preferences.
Recommendations/conclusion: The results indicate potential for improvement of care for women with EPL, such as supply with all three care options and evidence based information, as well as generating appropriate guidelines.
Ethical criteria and conflict of interests: The research was submitted to an ethics committee. It was financed from own resources. There is no conflict of interest.
The PDF file of the poster submitted for the meeting is available in German as Attachment 1 [Attach. 1].
References
- 1.
- ACOG. The American College of Obstetricians and Gynecologists Practice Bulletin no. 150. Early pregnancy loss. Obstet Gynecol. 2015;125(5):1258–67.
- 2.
- NICE. Ectopic pregnancy and miscarriage: Evidence Update December 2014; 2014. [Zugriff/cited Oct 2017]. Verfügbar unter/available from: https://www.evidence.nhs.uk/search?q=ectopic+pregnancy+and+miscarriage
- 3.
- Hosang B. Abort – Verlaufsformen. Geburtshilfe und Frauenheilkunde. 2013;73:213–8.
- 4.
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen. ‘Arbeitspapier - Analytic Hierarchy Process (AHP) - Pilotprojekt’. Köln: IQWIG; 2013.
