Women Know Best—Findings from a Thematic Analysis of 5,214 Surveys of Abortion Care Experience

Abstract

a b s t r a c tObjective: Patient experience is an essential component of quality care. Few studies have comprehensively evaluated patient experiences of abortion care. The objectives of this study were to describe women's experiences of abortion care in their own words, and to determine themes across patient experiences. Study Design: Data for this thematic analysis, a qualitative method that allows for the identification, analysis, and report of patterns or themes within data, come from a larger study of safety and quality of aspiration abortion care across 22 clinical sites. Participants completed an abortion experience survey including fixed choice questions and an open-ended question: "Is there anything you would like to tell us about your experience?" The data were then categorized by responses to another survey question: "Overall, was your experience about, better, or worse than you expected?" Results: A total of 5,214 responses were analyzed. Women reported positive abortion care experiences with the majority of women rating their experience as better than expected (n ¼ 3,600). Two major themes that emerged from the data include clinic-and patient-level factors that impact how patients rate their experiences. Analysis of the responses categorized in the worse than expected group (n ¼ 136) found that women primarily faulted clinic-level factors for their negative experiences, such as pain control and management, and wait time for appointments and in clinic. Conclusion: This analysis highlights specific areas of abortion care that influence patients' experience. The few women who were disappointed by care in the clinic tended to fault readily modifiable clinical factors, and provided suggested areas of improvement to enhance positive experiences related to their abortion care.

Factors influencing women's satisfaction with surgical abortion — reply

“…We agree with McLemore et al that patient satisfaction ratings are an inadequate measure of the overall patient care experience, which they reviewed in depth in their prior publications [2,3]. Rather than repeat the information already included in the commentary sections of their papers, we opted to use the discussion section of our report to point out the differences and similarities between the findings of the studies.…”

“…We agree with McLemore et al that their qualitative assessments demonstrated that patient satisfaction is just one component of patient experience and that patient satisfaction is not the sole determinant of patient experience [2]. Taylor et al [3] evaluated whether or not patients rated their care as excellent, whereas we looked at what factors influenced their level of satisfaction, even if the patient did not consider the care as excellent.…”

Radical or routine? Nurse practitioners, nurse-midwives, and physician assistants as abortion providers

“…The new California law advises following the same training protocol for experienced clinicians until 2016. Multiple publications detail the evidence generated by the study, including the safety of clinician provided aspiration abortion care, 11 multiple aspects of confidence development among clinicians while learning this skill, 12 patients' positive experience of early abortion care, 13,14 and the effective use of research to inform policy change. 15 It wasn't radical as far as the patients were concerned either.…”

“…13 In surveys of patients during the study, the patients reported high satisfaction with their abortion care experience, regardless of who provided the abortion. 13,14 Rather, patients identified several factors that influenced how they ranked their care experience, including interventions to decrease shame and/or stigma, their experiences of pain and pain management, the clinical environment, and waiting times associated with their appointment. 14 These findings found no association with the type of professional (clinician or physician) who delivered the abortion care, and reflect systemic issues common in diverse health care settings.…”

Factors influencing women's satisfaction with surgical abortion

“…Although few studies specifically explore acceptability of surgical abortion, [8,9] we might expect overall results similar to medical abortion. Although recent research has evaluated clinic-level factors that contribute to a positive abortion experience, we have little information on which factors are most influential to a women's overall satisfaction with surgical abortion [8,10]. We performed this survey study to investigate which factors influenced women's satisfaction during first-trimester surgical abortion.…”