早孕期不可行妊娠的语言：患者报告的偏好和清晰度。
The Language of First-Trimester Nonviable Pregnancy: Patient-Reported Preferences and Clarity.
机构信息
Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, the Division of Family Planning, and the Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Obstet Gynecol. 2019 Jan;133(1):149-154. doi: 10.1097/AOG.0000000000002997.
OBJECTIVE
To document the terminology patients hear during the treatment course for a nonviable pregnancy and to ask patients their perceived clarity and preference of terminology to identify a patient-centered lexicon.
METHODS
We performed a preplanned substudy survey of English-speaking participants in New York, Pennsylvania, and California at the time of enrollment in a randomized multisite trial of medical management of first-trimester early pregnancy loss. The six-item survey, administered on paper or an electronic tablet, was developed and piloted for internal and external validity. We used a visual analog scale and quantified tests of associations between participant characteristics and survey responses using risk ratios.
RESULTS
We approached 155 English-speaking participants in the parent study, of whom 145 (93.5%) participated. In the process of receiving their diagnosis from a clinician, participants reported hearing the terms "miscarriage" (n=109 [75.2%]) and "early pregnancy loss" (n=73 [50.3%]) more than "early pregnancy failure" (n=31 [21.3%]) and "spontaneous abortion" (n=21 [14.4%]). The majority selected "miscarriage" (n=79 [54.5%]) followed by "early pregnancy loss" (n=49 [33.8%]) as their preferred term. In multivariable models controlling for study site, ethnicity, race, history of induced abortion, and whether the current pregnancy was planned, women indicated that "spontaneous abortion" and "early pregnancy failure" were significantly less clear than "early pregnancy loss" (53/145, adjusted risk ratio 0.12, 95% CI 0.07-0.19 and 92/145, adjusted risk ratio 0.38, 95% CI 0.24-0.61, respectively, as compared with 118/145 for "early pregnancy loss"). "Miscarriage" scored similarly to "early pregnancy loss" in clarity (119/145, adjusted risk ratio 1.05, 95% CI 0.62-1.77).
CONCLUSION
The terminology used to communicate "nonviable pregnancy in the first trimester" is highly variable. In this cohort of women, most preferred the term "miscarriage" and classified both "miscarriage" and "early pregnancy loss" as clear labels for a nonviable pregnancy. Health care providers can use these terms to enhance patient-clinician communication.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT02012491.
目的
记录患者在非存活妊娠治疗过程中听到的术语，并询问患者对术语的清晰度和偏好，以确定以患者为中心的词汇。
方法
我们对在纽约、宾夕法尼亚和加利福尼亚参加一项早期妊娠丢失的医疗管理的随机多中心试验的英语参与者进行了预先计划的子研究调查。该六项目调查是为内部和外部有效性而开发和试点的。我们使用视觉模拟量表，并使用风险比量化参与者特征与调查反应之间的关联测试。
结果
我们在主要研究中接触了 155 名讲英语的参与者，其中 145 名（93.5%）参与了研究。在从医生那里得到诊断的过程中，参与者报告说听到了“流产”（n=109[75.2%]）和“早期妊娠丢失”（n=73[50.3%]）比“早期妊娠失败”（n=31[21.3%]）和“自然流产”（n=21[14.4%]）更频繁。大多数人选择“流产”（n=79[54.5%]），其次是“早期妊娠丢失”（n=49[33.8%]）作为他们喜欢的术语。在控制研究地点、族裔、种族、人工流产史和当前妊娠是否计划的多变量模型中，女性表示“自然流产”和“早期妊娠失败”比“早期妊娠丢失”明显不清晰（53/145，调整风险比 0.12，95%CI 0.07-0.19 和 92/145，调整风险比 0.38，95%CI 0.24-0.61，分别与 118/145 的“早期妊娠丢失”相比）。“流产”在清晰度方面与“早期妊娠丢失”相似（119/145，调整风险比 1.05，95%CI 0.62-1.77）。
结论
用于传达“孕早期非存活妊娠”的术语变化很大。在这组女性中，大多数人更喜欢“流产”这个术语，并将“流产”和“早期妊娠丢失”都归类为非存活妊娠的清晰标签。医疗保健提供者可以使用这些术语来加强医患沟通。
临床试验注册
ClinicalTrials.gov，NCT02012491。
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