Choices about abortion method: assessing the quality of patient information leaflets in England and Wales

Abstract

Objective To assess the quality of patient leaflets regarding the choice between medical and surgical abortions.Design Cross sectional survey.Setting NHS and private providers of abortion services in England and Wales.Sample Leaflets from three private providers, all teaching hospitals (n ¼ 14) and a representative sample of NHS district hospitals (n ¼ 27), accessed by approximately 100,000 women per year. Methods On telephoning the above abortion services, the leaflets provided to women choosing to have medical or surgical abortions were requested. Content analysis of leaflets included: application of a coding frame assessing adequacy of information about options, risks and procedures; the Flesch Readability Ease scale. Main outcome measures Provision of leaflet, adequacy of information and ease of readability.Results Seventy-three percent (44/60) of contacted providers offered women a leaflet. Of these 44 leaflets, one mentioned medical and 15 surgical abortion methods only. Adequacy of information provision was low, with on average 10/23 points covered about the surgical method, 12/21 points about the medical method and 7/11 points about aftercare. Readability scores were poor with 24/44 (55%) rated as 'difficult' or 'fairly difficult'. Among NHS providers, scores were slightly higher in the teaching than in the district hospitals. Conclusions On average, leaflets provided half the information possible about the risks and procedures of medical and surgical methods. In addition, readability was rated as difficult in over half the leaflets. It seems unlikely that these leaflets enable women to make informed choices between abortion methods and, therefore, do not meet the requirements of current guidelines.

Medical vs. surgical abortion: the importance of women's choice

“…This proportion is higher than the 11% of women in the Danish trial, who expressed no preferences and were willing to be randomized to receive either treatment [7]. Insufficient or poor quality information may be a barrier to achieve greater patient autonomy [14], but changes in the approach to clinician-patient partnerships may also take time to fully be integrated in the French health care system.…”

Medical versus surgical methods of early abortion: protocol for a systematic review and environmental scan of patient decision aids

“…Evidence from the UK indicates that some information materials designed for this purpose are inadequate, unbalanced and difficult to read. 15 However, we are not aware of equivalent research in the USA or elsewhere. Such research is particularly important in the USA where abortion is simultaneously a highly prevalent and yet highly stigmatized 16 procedure, and where there remains widespread misinformation, 17 18 poor access to services, 1 and broad variability in abortion counselling practices.…”

Patient Evaluation of a Novel Patient Education Leaflet About Heart Disease Risk Among People with Rheumatoid Arthritis

“…However, with increasing emphasis on patients' experience in the health service, we believe that ensuring the quality of educational material is also important, paying attention to factors such as presentation, font size and suitability of graphics. Other specialties have assessed the quality of their leaflets, but health professionals, rather than patients, have assessed them (White et al, ; Winterbottom et al, ; Wong et al, ), often focusing on content and readability alone (Winterbottom et al, ; Wong et al, ). If the leaflet is designed for patients, then it is logical that their opinion should be sought to ensure that it addresses their questions and is presented in a user‐friendly style (Coulter, ).…”

“…The balance between content and readability is crucial. It has been suggested that inadequate attention has been paid towards the content of patient leaflets (Coulter, ) and inaccuracies or omissions have certainly been identified in leaflets (White et al, ; Winterbottom et al, ; Wong et al, ). Patients identified that our novel CVD‐RA leaflet lacked detail about what sources of information had been used to compile the leaflet, when this information had been produced and the risks associated with its advice; similar findings were observed in a review of 31 renal replacement therapy leaflets available nationwide (Winterbottom et al, ).…”