患者和提供者对早产风险评估和沟通的看法。
Patient and provider perspectives on preterm birth risk assessment and communication.
机构信息
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.
出版信息
Patient Educ Couns. 2021 Nov;104(11):2814-2823. doi: 10.1016/j.pec.2021.03.038. Epub 2021 Apr 1.
OBJECTIVE
To describe and compare how obstetric patients and care providers view preterm birth risk assessment and communication.
METHODS
We conducted eight focus groups with obstetric patients (n = 35) and 16 qualitative interviews with obstetric providers. Grounded theory was used to identify and analyze themes.
RESULTS
Patients' knowledge about preterm birth varied greatly. Similar benefits and risks of preterm birth risk counseling were discussed by patients and providers with notable exceptions: patients cited preparedness as a benefit and providers cited maternal blame, patient alienation, and estimate uncertainty as potential risks. Most patients expressed a desire to know their personalized preterm birth risk during pregnancy. Providers differed in whether they offer universal versus selective, and quantitative versus qualitative, preterm birth risk counseling. Many providers expressed concern about discussing social and structural risk factors for preterm birth.
CONCLUSION
While many patients desired knowing their personalized preterm birth risk, prenatal care providers' disclosure practices vary because of uncertainty of estimates, concerns about negative consequences and challenges of addressing systemic inequities and social determinants of health.
PRACTICE IMPLICATIONS
Given the existing asymmetry of information about preterm birth risk, providers should consider patient preferences regarding and potential benefits and risks of such disclosure in their practice.
目的
描述并比较产科患者和医护人员如何看待早产风险评估和沟通。
方法
我们对 35 名产科患者进行了 8 组焦点小组讨论，并对 16 名产科医护人员进行了定性访谈。采用扎根理论来识别和分析主题。
结果
患者对早产的了解差异很大。患者和医护人员讨论了早产风险咨询的相似益处和风险，但也有明显的例外：患者认为有准备是一种益处，而医护人员则认为可能存在母亲责备、患者疏远和估计不确定性等风险。大多数患者表示希望在怀孕期间了解自己的个性化早产风险。医护人员在提供普遍的还是选择性的、定量的还是定性的早产风险咨询方面存在差异。许多医护人员对讨论早产的社会和结构性风险因素表示担忧。
结论
虽然许多患者希望了解自己的个性化早产风险，但由于估计的不确定性、对负面后果的担忧，以及解决系统性不平等和健康的社会决定因素的挑战，产前护理提供者的披露实践存在差异。
实践意义
鉴于有关早产风险的信息存在不对称，提供者在实践中应考虑患者对这种披露的偏好以及潜在的益处和风险。
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