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

项目总结/摘要 女性手术绝育是美国第二大最常用的避孕方法， 低收入女性和有色人种女性使用的比例过高。是否使用较高的灭菌 这些人口反映了不适当的过度使用，目前尚不清楚。一方面，低收入和种族 少数民族妇女经常误解绝育的永久性，往往不知道 可逆的避孕替代品，并且通常在手术后感到后悔-这表明 次优决策另一方面，有证据表明， 由于医疗补助绝育造成的独特的获取障碍，低收入妇女中的绝育 法规，使她们处于意外怀孕的高风险之中，并对健康和社会造成不利影响。 与意外怀孕有关的后果。 医疗补助绝育政策目前要求所有申请联邦资助程序的妇女 在绝育前至少30天填写一份标准化的同意书。这项政策最初是 20世纪70年代设立，旨在保护弱势妇女免受强制绝育做法的影响， 确保知情和自愿同意。然而，越来越多的人认为，这项政策无法 确保知情同意，强制性的30年等待期阻碍了获得所需的绝育 对于很多低收入的女性来说。缺乏既能确保知情同意又能确保及时获取的程序 对绝育手术的歧视阻碍了低收入妇女在生殖健康公平方面取得进展。 拟议的项目旨在建立和测试一个新的，基于网络的决策支持工具，以优化低收入 妇女有能力就绝育手术作出知情和价值观一致的决定。决定 支持工具在消毒决策的背景下可能特别有用，因为这是一种偏好- 这是一个具有永久影响的敏感决定，因为人们对 绝育和接受手术的妇女对其他选择的认识有限， 这表明在绝育前咨询的质量方面存在严重差距。此外，患者与提供者的互动 贫穷和少数民族妇女的处境可能因更广泛的社会和历史背景而复杂化， 生殖选择并不总是受到重视。因此，本提案的具体目标是从质量上 确定低收入妇女的决策支持需求和偏好，以及提供者对以下问题的看法： 决策支持在外科绝育中的作用（目标1）;建立一个以患者为导向的、基于网络的决策 帮助支持妇女的绝育决策（目标2）;并进行3个地点的随机对照试验 在350名受试者中，测试决策辅助加上常规护理与单独常规护理对决策质量的影响。 要求产后绝育的不同种族低收入妇女（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).