Developing and testing a decision support tool for women making tubal sterilization decisions.

项目摘要/摘要 女性手术绝育是美国第二大最常用的避孕方法， 不成比例地被低收入女性和有色人种女性使用。是否更高的灭菌使用率 这些人口反映了不适当的过度使用尚不清楚。一方面，低收入和种族 少数族裔妇女经常误解绝育的永久性性质，往往不知道 可逆的避孕替代方案，通常在手术后感到后悔--建议 次优决策。另一方面，有证据表明，大量未得到满足的需求 由于医疗补助绝育带来的独特获得障碍，低收入妇女中的绝育 法规，使她们面临意外怀孕的高风险以及对健康和社会的不利影响 与意外怀孕相关的后果。 医疗补助绝育政策目前要求所有申请联邦资助的程序的妇女 至少在绝育前30天填写一份标准化同意书。这项政策最初是 成立于20世纪70年代，旨在保护弱势妇女免受强制绝育做法的影响，方法是试图 确保知情和自愿同意。然而，越来越多的人达成共识，认为这项政策无法 确保知情同意，并且强制性的30个等待期阻碍了获得所需的绝育 对于许多低收入女性来说。缺乏既能确保知情同意又能确保及时获取的程序 因为绝育程序阻碍了实现低收入妇女生殖健康公平的进展。 拟议的项目旨在建立和测试一种新的、基于网络的决策支持工具，以优化低收入者 妇女对手术绝育做出知情和与价值一致的决定的能力。一个决定 支持工具在灭菌决策中可能特别有用，因为这是一种偏好- 具有永久性影响的敏感决定，因为对 绝育手术和接受手术的女性对替代选择的认识有限， 表明绝育前咨询的质量存在严重差距。此外，患者与提供者之间的互动 可能会因为更广泛的社会和历史背景而变得复杂，在这种背景下，贫穷和少数族裔妇女的 生殖选择并不总是受到重视。因此，这项提案的具体目标是定性地 确定低收入妇女的决策支持需求和偏好以及提供者对 围绕手术绝育的决策支持的作用(目标1)；建立以患者为导向的、基于网络的决策 协助妇女作出绝育决定(目标2)；并进行3个地点的随机对照试验 在350名受试者中，测试辅助决策加常规护理与单独常规护理对决策质量的影响 要求产后绝育的种族多元化、低收入妇女(目标3)。

Project Summary/ Abstract Female surgical sterilization is the second most commonly used contraceptive method in the US and is disproportionately used by low-income women and women of color. Whether the higher use of sterilization in these populations reflects inappropriate overutilization is unclear. On one hand, low-income and racial minority women frequently misunderstand the permanent nature of sterilization, are often unaware of reversible contraceptive alternatives, and commonly experience regret after the procedure– suggesting suboptimal decision making. On the other hand, there is evidence of substantial unmet demand for sterilization among low-income women, due to unique access barriers posed by Medicaid sterilization regulations, putting them at high risk for unintended pregnancy and the adverse health and social consequences associated with unintended pregnancy. Medicaid sterilization policy currently requires that all women requesting a federally-funded procedure complete a standardized consent form at least 30 days prior to sterilization. This policy was originally instituted in the 1970s to protect vulnerable women from coercive sterilization practices by attempting to ensure informed and voluntary consent. However, there is growing consensus that the policy is incapable of ensuring informed consent, and that the mandatory 30-waiting period impedes access to desired sterilization for many low-income women. The lack of a process that can ensure both informed consent and timely access for sterilization procedures hampers progress toward reproductive health equity for low-income women. The proposed project seeks to build and test a novel, web-based decision support tool to optimize low-income women's ability to make informed and value-concordant decisions about surgical sterilization. A decision support tool may be particularly useful in the context of sterilization decisions because this is a preference- sensitive decision with permanent implications and because there is a high level of misunderstanding about sterilization and limited awareness of alternative options among women who have undergone the surgery, indicating critical gaps in the quality of pre-sterilization counseling. Furthermore, patient-provider interactions may be complicated by a broader social and historical context in which poor and minority women's reproductive choices have not always been valued. Thus, the specific aims of this proposal are to qualitatively determine low-income women's decision support needs and preferences as well as providers' perspectives on the role of decision support around surgical sterilization (Aim 1); build a patient-directed, web-based decision aid to support women's sterilization decision making (Aim 2); and conduct a 3-site, randomized controlled trial to test the effect of the decision aid plus usual care compared to usual care alone on decision quality among 350 racially-diverse, low-income women requesting post-partum sterilization (Aim 3).