It’s a small bit of advice, but actually on the day, made such a difference…: perceptions of quality in abortion care in England and Wales

Abstract

Background Quality of care (QOC) is increasingly identified as an important contributor to healthcare outcomes, however little agreement exists on what constitutes quality in abortion care or the recommended indicators from the service-user perspective. Our study aimed to explore perceptions and experiences of abortion QOC in England and Wales. Methods We performed in-depth interviews (via phone or in-person) with participants who had an abortion at a nationwide independent sector provider in the previous 6 months. We explored their experiences of the abortion service at each point in the care pathway, their perspectives on what contributed to and detracted from the experience meeting their definitions of quality, and their reflections on different aspects of QOC. We used content analysis to generate themes. Results From December 2018 to July 2019, we conducted 24 interviews. Ten participants had a surgical and 14 had a medical abortion. Seventeen (71%) were treated in the first 12 weeks of pregnancy and 7 (29%) beyond that, with an average gestational age of 10 weeks + 5 days (range 5–23 + 6). We identified 4 major themes that contributed to participant’s perception of high quality care: (1) interpersonal interactions with staff or other patients, (2) being informed and prepared, (3) participation and choices in care and (4) accessibility. Nearly all participants identified interpersonal interactions with staff as an important contributor to quality with positive interactions often cited as the best part of their abortion experience and negative interactions as the worst. For information and preparation, participant described not only the importance of being well prepared, but how incongruencies between information and the actual experience detracted from quality. Participants said that making choices about their care, for example, method of abortion, was a positive contributor. Finally, participants identified access to care, specifically in relation to waiting times and travel, as an important aspect of QOC. Conclusions Participants situated quality in abortion care in 4 domains: interpersonal aspects of care, information and preparation, choices, and accessibility. Indicators identified can be used to develop standard metrics to ensure care meets service-user needs.

Opt-in versus universal codeine provision for medical abortion up to 10 weeks of gestation at British Pregnancy Advisory Service: a cross-sectional evaluation

“…Our data are unable to explain why there is an association between opt-in codeine and greater satisfaction with pain management; however, we postulate that the opt-in approach prompted clinicians to have a more detailed discussion of pain, which better prepared patients for the experience. Our findings align with results from qualitative abortion research that suggest that patients value information, preparation and choice as markers of quality abortion care 24–26. Evidence also shows that pre-abortion information, particularly regarding pain and side effects, can reduce anxiety during the abortion and create a more positive experience overall 27…”

How can patient experience of abortion care be improved? Evidence from the SACHA study

“…The high levels of satisfaction with abortion care in Britain have been reflected in research by others. 25 , 26 , 27 , 28 Of interest in the context of this enquiry are the specific features of the abortion experience reported as impacting positively and negatively on the abortion experience, the extent to which they appear contingent on changes in models of care and the suggestions made by patients for improving their experience.…”

“…Appeals by our participants for reassurance to reduce anxiety during the waiting time align with the recommendations made in recent literature. 27 Patients’ suggestions for measures to reduce delays included widening and updating informational sources; raising awareness of the possibility of self-referral; and ensuring that health professionals other than specialist abortion providers had the necessary knowledge to signpost appropriately to avoid confusion over which services should be approached. The recommendations made in national abortion care guidelines for streamlined, integrated services and centralized referral 29 are of particular relevance in the context of England and Wales, where three major independent providers all have separate booking systems, with no clear indication to patients as to which they should opt for, even though sole-provider contracts remain in many areas.…”

“Almost like it was really underground”: a qualitative study of women’s experiences locating services for unintended pregnancy in a rural Australian health system

“…Participants in our study were thus exposed to a range of healthcare provider attitudes, expertise and varying levels of support, which is noted in other studies as having a significant influence on the individual’s quality of care. 36 , 38–42 …”