Barriers to D&amp;E practice among family planning subspecialists

Turk, Jema K.; Steinauer, Jody; Kerns, Jennifer L.

doi:10.1016/j.contraception.2013.04.011

Cited by 13 publications

(11 citation statements)

References 20 publications

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“…Second, several teams have shown that RNs and other staff who object to abortion care pose a major barrier to its provision (Guiahi, Lim, Westover, Gold & Westhoff, 2013;Turk, Steinauer, Landy & Kerns, 2013), and our data show several reasons for this, particularly, the degree to which RNs weigh the role and opinion of others, in addition to their own attitudes, beliefs and knowledge, when determining if they will provide care to women needing abortions. Perceived or real retaliation from colleagues, physicians and other staff influences how RNs tune their calculi.…”

Section: Discussionmentioning

confidence: 65%

Calculus Formation: Nurses’ Decision‐Making in Abortion‐Related Care

McLemore

Kools

Levi

2015

Research in Nursing & Health

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Nurses routinely provide care to patients in ethically challenging situations. To explore the continuum between conscientious objectors and designated staff in the provision of care to women seeking abortions, the aim of this study was to thickly describe decision-making, using abortion as the clinical context to elucidate how nurses approach ethically challenging work. A purposive sample of 25 nurses who worked in abortion clinics, emergency departments, intensive care units, labor, and delivery, operating rooms, and post anesthesia care units were interviewed. Qualitative description and thematic analysis were used to identify the cognitive, emotional, and behavioral processes in nurses' decisions to care for women needing abortions. Nurses developed and used multifaceted, realtime calculi when making decisions about their participation in emergent or routine abortion care. Nurses tacked back and forth between the personal and professional and/or held multiple contradictory positions simultaneously. Nurses weighed the role and opinion of others to determine if they know how to or know why they would provide abortion care to women, particularly in the elective abortion context. The parameters of the nurse-patient relationship were complex and specific to the experiences of both the nurse and patient. Findings from this study further develop the science of ethically challenging decision-making and expand our understanding of factors that influence how nurses develop relationships to ethically challenging work. ß

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Section: Discussionmentioning

confidence: 65%

Calculus Formation: Nurses’ Decision‐Making in Abortion‐Related Care

McLemore

Kools

Levi

2015

Research in Nursing & Health

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“…Indeed, Stulberg Dude Dahlquist and Curlin () found that although 97% of obstetrician‐gynecologists encounter patients seeking abortion, only 14% of the respondents performed the procedure. The lack of physicians who provide abortion in a hospital setting particularly impacts patients who have a fetal anomaly identified later in pregnancy (Kerns et al, ; Turk, Steinauer, Landy, & Kerns, ).…”

Section: Discussionmentioning

confidence: 99%

Exploring prenatal genetic counselors' perceptions of abortion laws in restrictive states

Koenig

Simi

Goldenberg

et al. 2019

Journal of Genetic Counseling

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In many states, abortion laws are becoming increasingly restrictive. Prenatal genetic counselors often see patients after the diagnosis of a fetal abnormality or genetic disorder and discuss the option of termination of pregnancy. The purpose of this study was to understand prenatal genetic counselors' perspectives on how state abortion laws impact their practice. Qualitative semi‐structured interviews were conducted with 16 prenatal genetic counselors in states with restrictive abortion laws who were recruited from the National Society of Genetic Counselors' online directory. Verbatim transcripts were analyzed thematically, yielding five themes: genetic counselors in this study described (a) how state laws restrict access to abortion; (b) how they navigate state laws and institutional policies regarding abortion; (c) how they tailor their professional practice in the context of state abortion laws; (d) how abortion laws burden patients; and (e) how they engage in forms of advocacy. Participants described the financial and emotional burden placed on their patients by state abortion laws and how the laws influence their patient interactions. As access to abortion becomes more restricted, it is important to be aware of how this will impact genetic counselors and their patients.

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“…Our qualitative findings suggest that some MFMs would like to be able to offer D&Es to their patients and spare them the burden of being referred to another provider; however, insurance-related barriers and difficulty with navigating complex health care delivery systems make it difficult for them to do so. FP subspecialists also report logistical barriers, and experiencing those barriers is associated with practicing in less restrictive regions, in a hospital-based practice, with lower D&E volume [14]. Both FP subspecialists and MFMs incorporating D&E into their practice would benefit greatly from more streamlined systems for D&E provision, and those in academic, hospital-based settings may benefit the most.…”

Section: Discussionmentioning

confidence: 99%

“…The decision to include D&E in their scope of practice is likely related to practice setting, desire for continuity of care with patients, institutional culture, and training. Family planning (FP) subspecialists most frequently report unsupportive nursing staff, logistical issues, and unsupportive administration as barriers to D&E provision [14]. Given the training and practice differences between MFMs and FPs, MFMs may encounter different barriers to D&E provision.…”

Section: Introductionmentioning

confidence: 99%

Barriers to dilation & evacuation practice among Maternal-Fetal Medicine subspecialists: quantitative and qualitative results from a national survey

Kerns¹,

Lederle²,

Rosenstein³

et al. 2016

Clin Obstet Gynecol Reprod Med

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Objective: To quantitatively and qualitatively describe specific barriers encountered by Maternal-Fetal Medicine (MFM) subspecialists to providing second-trimester termination by dilation and evacuation (D&E) using a mixed methods approach. Methods:We surveyed all members of the Society for Maternal-Fetal Medicine, and all faculty and fellows associated with MFM fellowships regarding practice characteristics and barriers to second-trimester termination. We categorized barrier responses into five categories: lack of training, logistical issues, negative culture, personal issues and no barriers. We compared respondent characteristics across barrier categories. We qualitatively analyzed barrier-related themes from respondents' comments using a grounded theory approach. Results:Of the 689 (32%) physicians who completed the survey, 591 (86%) reported at least one barrier to D&E provision. Main barriers among D&E providers (n=216) and D&E non-providers (N=473) differed, with providers reporting negative culture (37%) and logistical issues (33%) and non-providers reporting personal issues (36%) and lack of training (28%). Qualitative themes related to practice barriers paralleled the above categories. Conclusion:Addressing logistical barriers faced by D&E providers may streamline D&E services. Establishing routine D&E training in MFM fellowships is critical for supporting MFMs who wish to provide D&E. Collaborative partnerships with family planning subspecialists may facilitate this process.

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Barriers to D&E practice among family planning subspecialists

Cited by 13 publications

References 20 publications

Calculus Formation: Nurses’ Decision‐Making in Abortion‐Related Care

Calculus Formation: Nurses’ Decision‐Making in Abortion‐Related Care

Exploring prenatal genetic counselors' perceptions of abortion laws in restrictive states

Barriers to dilation & evacuation practice among Maternal-Fetal Medicine subspecialists: quantitative and qualitative results from a national survey

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