Disseminating PCOR findings to Reduce Racial Disparities in Surgical Sterilization

摘要： 本提案是根据RFA-HS-22-001提交的，属于“改善产妇保健”优先领域， 由于长期存在的种族和民族差异，在使用永久避孕（历史上称为 “外科绝育”）。在美国，永久性避孕手术最常在 有色人种妇女、患有糖尿病等慢性病的妇女以及居住在农村社区的妇女。 虽然永久避孕与一些患者的生殖生活计划保持一致，但报告称， 后悔接受这些手术的妇女令人不安。这些遗憾和种族差异是 鉴于最近的变革和组织振兴方案表明， 激素宫内节育器比永久性避孕药更有效，也不太可能引起盆腔疼痛 程序.传播变革和组织振兴方案关于替代品的相对安全性和实际有效性的信息， 为了实现永久避孕，我们将调整预先护理计划框架，该框架已被用于 确保患者在接近生命终点时接受与其个人健康状况相一致的医疗护理， 治疗目标。这种模式是支持患者做出复杂医疗决策的关键工具， 通过强调价值观的启发、沟通技能的培养和共同决策。通过制备 患者接近其生殖生命的结束，以更有效地向临床医生沟通， 个人价值观、优先事项和治疗目标，我们将采用ACP模式进行生殖生命规划 (RLP)患者（目标1，焦点小组）和临床医生（目标2，半结构化访谈）的输入。我们将 然后进行一项个体水平的随机临床试验，比较这种方法与传播PCOR 与300名黑人或患有慢性疾病的妇女讨论永久避孕有关 糖尿病等疾病，以及希望避免未来怀孕的人（目标3）。在评估这一干预措施时，我们 经验丰富的多学科团队将仔细检查与沟通相关的患者报告结局 和对护理的满意度。我们还将通过临床和实验室研究， 患者水平的背景因素，以告知未来改进这种ACP-RLP范例的潜在需求。通过 增加公平获得永久避孕替代品的机会，该项目力求增加 使用符合个人偏好的避孕方法的美国女性比例 减少后悔接受永久性避孕手术的人的比例。

Abstract: This proposal, submitted in response to RFA-HS-22-001, in the priority area of “improving maternal health,” is prompted by long-standing racial and ethnic disparities in use of permanent contraception (historically called “surgical sterilization”). In the US, permanent contraceptive procedures are most commonly performed on women of color, women with chronic conditions such as diabetes, and those residing in rural communities. Although permanent contraception aligns well with some patients’ reproductive life plans, reports that 10% of women regret having undergone these procedures are troubling. These regrets and racial disparities are especially problematic given recent PCOR demonstrating that long-acting reversible contraceptives, such as hormonal IUDs are both more effective and less likely to cause pelvic pain than permanent contraceptive procedures. To disseminate PCOR about the comparative safety and real-world effectiveness of alternatives to permanent contraception, we will adapt the advance care planning (ACP) framework, which has been used to ensure that patients receive medical care when approaching their end of life that aligns with their personal treatment goals. This paradigm is a critical tool for supporting patients in making complex medical decisions, by emphasizing elicitation of values, communication skill building, and shared decision-making. By preparing patients approaching the end of their reproductive life to more effectively communicate to clinicians their personal values, priorities, and treatment goals, we will adapt the ACP model for reproductive life planning (RLP), with input from patients (Aim 1, focus groups) and clinicians (Aim 2, semi-structured interviews). We will then conduct an individual-level randomized clinical trial comparing this approach to disseminating PCOR relevant to discussions of permanent contraception with 300 women who identify as Black or have a chronic condition such as diabetes, and who wish to avoid future pregnancy (Aim 3). In evaluating this intervention, our experienced multi-disciplinary team will carefully examine patient-reported outcomes related to communication and satisfaction with care. We will also rigorously analyze heterogeneity of treatment effects by clinical and patient-level contextual factors to inform the potential need for future refinement of this ACP-RLP paradigm. By increasing equitable access to alternatives to permanent contraception, this project strives to increase the proportion of US women who are using a method of contraception that aligns with their personal preferences and reduce the proportion of individuals who regret having undergone a permanent contraceptive procedure.