Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Womens Health Issues. 2024 Nov-Dec;34(6):572-579. doi: 10.1016/j.whi.2024.06.005. Epub 2024 Aug 2.
We sought to understand how patients and physicians conceptualize uncertainty in the permanent contraception decision-making process.
In 2022-2023, we interviewed postpartum patients with a documented desire for permanent contraception (n = 81) and their delivering physicians (n = 67). Eligible patients gave birth at one of our four study hospitals in California, Ohio, Illinois, and Alabama. We used rapid content analysis and thematic content analysis to develop and refine themes related to uncertainty in permanent contraceptive decision-making.
Most patients reported full certainty in their decision regarding permanent contraception, although some expressed doubts. After receiving permanent contraception, some patients discussed grief but overall affirmed their decision. One patient said they wished they had considered other contraceptive options. Physicians reported using a range of strategies to safeguard from patient regret, including ensuring patients were 100% certain with their decision, inferring certainty based on their characteristics, asking patients to think through all scenarios that could affect decision-making, and repeat counseling during multiple interactions.
Patient experiences reveal the depth, fluidity, and nuance of patients' contraceptive decision-making processes. Physicians sometimes failed to grapple with this nuance by centering potential regret in their counseling. Personalized and supportive contraceptive counseling that acknowledges the complexity of contraceptive decision-making is imperative. Shared decision-making can help ensure patients can make informed and autonomous decisions about their reproductive lives.
我们试图了解患者和医生如何在永久性避孕决策过程中理解不确定性。
在 2022-2023 年，我们采访了有记录表明希望进行永久性避孕的产后患者（n=81）及其接诊医生（n=67）。符合条件的患者在我们位于加利福尼亚州、俄亥俄州、伊利诺伊州和阿拉巴马州的四家研究医院之一分娩。我们使用快速内容分析和主题内容分析来开发和完善与永久性避孕决策不确定性相关的主题。
大多数患者报告对永久性避孕决定完全有把握，尽管有些患者表示怀疑。在接受永久性避孕后，一些患者讨论了悲痛，但总体上肯定了他们的决定。一位患者表示，他们希望自己考虑过其他避孕选择。医生报告使用了一系列策略来避免患者后悔，包括确保患者对他们的决定 100%确定，根据他们的特征推断出确定性，要求患者考虑所有可能影响决策的情况，并在多次互动中重复咨询。
患者的经历揭示了患者避孕决策过程的深度、流动性和细微差别。医生有时未能理解这种细微差别，而是将潜在的后悔作为咨询的重点。个性化和支持性的避孕咨询，承认避孕决策的复杂性是至关重要的。共同决策可以帮助确保患者能够对他们的生殖生活做出明智和自主的决定。
