Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review
Notice bibliographique
Résumé
Abstract Objectives To synthesise evidence on user experience of medical abortion at home To develop a realist programme theory to explain what interventions improve user experience for whom and in what context. To use this programme theory to develop recommendations for service providers and those having medical abortions at home Background Changes in the therapeutic, technological and regulatory landscape are increasing access to medical abortion at home. This intervention is safe, effective and acceptable to most. Clinical pathways and user experience are nevertheless variable and a minority would not choose this method again. We synthesised evidence to inform service development and responsiveness for different people and contexts. Methods We used a realist approach to literature review that starts from an initial programme theory and generates causal explanations in the form of context-mechanism-outcome configurations to test and develop that theory. We searched the literature 01/01/2000 - 09/12/2022 using broad search terms and then selected papers for their relevance to theory development in contexts relevant to service development in the UJ. Data were analysed using a realist approach to analysis to develop causal explanations. Results Our searches identified 12,517 potentially relevant abstracts with 835 selected for the full text assessment and 49 papers included in the final review. Our synthesis suggests that having a choice of abortion location remains essential as some people are unable to have a medical abortion at home. Choice of place of abortion (home or clinical setting) was influenced by service factors (number, timing and wait for appointments), personal responsibilities (caring/work commitments), geography (travel time/distance), relationships (need for secrecy) and wish to be aware of/involved in the process. We found that the option for self-referral through a telemedicine consultation, realistic information on range of experiences, opportunities to personalise the process, improved pain relief and choice of when and how to discuss contraception could improve experience. Discussion Acknowledging the work done by patients when moving an intervention from clinic to home is important. This includes preparing a space, managing privacy, managing work/caring obligations, deciding when/how to take medications, understanding what is normal, assessing experience and deciding when and how to ask for help. Strategies that reduce surprise or anxiety and enable preparation and a sense of control support the transition of this complex intervention outside healthcare environments. Strenghts and limitations – Strengths: systematic and transparent approach to the realist review, which was conducted in accordance with the RAMSES standards (27); Authorship team represents a variety of clinical and academic backgrounds – Limitations: analysis on publicly accessible literature, located through recognised research databases and Google; there were gaps in the evidence that we found and we have highlighted these in our conclusions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».