Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland.
INFANT Research Centre, University College Cork, Cork, Ireland.
BMC Health Serv Res. 2023 Mar 31;23(1):317. doi: 10.1186/s12913-023-09347-1.
Learning what matters to women/couples with recurrent miscarriage (RM) is essential to inform service improvement efforts and future RM care practices. Previous national and international surveys have examined inpatient stays, maternity care, and care experiences around pregnancy loss, but there is little focus on RM care. We aimed to explore the experiences of women and men who have received RM care and identify patient-centred care items linked to overall RM care experience.
Between September and November 2021, we invited people who had experienced two or more consecutive first trimester miscarriages and received care for RM in Ireland in the ten-year period prior to participate in a cross-sectional web-based national survey. The survey was purposefully designed and administered via Qualtrics. It included questions on sociodemographics, pregnancy and pregnancy loss history, investigation and treatment for RM, overall RM care experience, and patient-centred care items at various stages of the RM care pathway such as respect for patients' preferences, information and support, the environment, and involvement of partners/family. We analysed data using Stata.
We included 139 participants (97% women, n = 135) in our analysis. Of the 135 women, 79% were aged 35-44 years (n = 106), 24% rated their overall RM care experience as poor (n = 32), 36% said the care they received was much worse than expected (n = 48), and 60% stated health care professionals in different places did not work well together (n = 81). Women were more likely to rate a good care experience if they had a healthcare professional to talk to about their worries/fears for RM investigations (RRR 6.11 [95% CI: 1.41-26.41]), received a treatment plan (n = 70) (RRR 3.71 [95% CI: 1.28-10.71]), and received answers they could understand in a subsequent pregnancy (n = 97) (RRR 8 [95% CI: 0.95-67.13]).
While overall experience of RM care was poor, we identified areas that could potentially improve people's RM care experiences - which have international relevance - such as information provision, supportive care, communication between healthcare professionals and people with RM, and care coordination between healthcare professionals across care settings.
了解反复性流产（RM）患者/夫妇的关注点对于改进服务和未来的 RM 护理实践至关重要。先前的国内外调查研究了住院治疗、产妇护理以及与妊娠丢失相关的护理体验，但很少关注 RM 护理。我们旨在探索接受 RM 护理的女性和男性的体验，并确定与 RM 整体护理体验相关的以患者为中心的护理项目。
在 2021 年 9 月至 11 月期间，我们邀请了在过去十年中经历过两次或两次以上连续早期流产，并在爱尔兰接受 RM 治疗的患者参与一项基于网络的全国性横断面调查。该调查是经过精心设计并通过 Qualtrics 进行管理的。它包括社会人口统计学、妊娠和妊娠丢失史、RM 的调查和治疗、RM 整体护理体验以及 RM 护理路径各个阶段的以患者为中心的护理项目，例如尊重患者的偏好、信息和支持、环境以及伴侣/家属的参与。我们使用 Stata 对数据进行了分析。
我们对 139 名参与者（97%为女性，n=135）进行了分析。在 135 名女性中，79%年龄在 35-44 岁（n=106），24%（n=32）对 RM 整体护理体验评价较差，36%（n=48）表示她们接受的护理比预期的差得多，60%（n=81）表示不同地点的医疗保健专业人员之间协作不佳。如果女性有可以倾诉 RM 检查的担忧/恐惧的医护人员（RRR 6.11 [95% CI：1.41-26.41]）、接受了治疗计划（n=70）（RRR 3.71 [95% CI：1.28-10.71]）和在后续妊娠中获得了她们可以理解的答案（n=97）（RRR 8 [95% CI：0.95-67.13]），她们更有可能评价护理体验良好。
尽管 RM 护理的整体体验较差，但我们确定了一些可能会改善人们的 RM 护理体验的领域，这些领域具有国际相关性，例如信息提供、支持性护理、医护人员与 RM 患者之间的沟通以及医疗保健专业人员在不同环境中的护理协调。
