October 28, 2015 — Summary of "Factors Influencing Women's Satisfaction with Surgical Abortion," Candice Tilles et al., Sept. 24, 2015.
Although "multiple studies investigate acceptability of medica[tion] abortion, much less has been published in the last 15 years about factors influencing women's satisfaction with surgical abortion," according to Candice Tilles of the Harbor-UCLA Medical Center's Department of Obstetrics and Gynecology and colleagues.
The researchers "performed this study to investigate which factors influenced women's satisfaction during first trimester surgical abortion."
For the study, researchers recruited participants "between May and December 2014 in two systems, four clinics in System A and two clinics in System B." Tilles and colleagues asked "women having a first trimester surgical abortion" at the participating sites "to complete an anonymous satisfaction survey after their procedure." Eligible participants "were 18 years or older, had a surgical abortion at 14 weeks gestation or less without any sedation, and could read and write English."
According to the researchers, "Patients at each clinic receive support as needed throughout the entire process from a trained non-physician counselor who was assigned to that patient upon arrival." Patients have an initial counseling session, which includes contraceptive counseling "as desired by the patient." According to the study, patients at System A were allowed to "bring a spouse, family member or friend into the procedure room," but those at System B were not.
After the procedure, patients spend 30 minutes in a recovery room under the supervision of a nurse. Participants were offered the survey in the recovery room. The survey consisted of 38 questions, including two questions "verif[ying] eligibility" and 13 questions about patients' demographics and their pregnancy history. The rest of the survey "inquired about satisfaction with 17 distinct aspects of the abortion experience" and "asked women to rank the three most important factors that contributed to their level of satisfaction."
The researchers included 210 women in their final analysis, and found that 79% of women at System A and 84% of women at System B "were very satisfied with their overall experience." According to the study, 92% of women "were satisfied with the overall abortion experience, including 82% who reported being 'very satisfied' and 10% who reported being 'somewhat satisfied.'" Meanwhile, 2% of women at System A and 1% of women at System B said they "were neutral or not satisfied."
The researchers also found that the "top three aspects of care that women ranked as most important to their level of satisfaction were the same at both systems: ability to get an appointment in a timely manner, courtesy of staff, and being informed as much as they wanted to know." According to the researchers, women at both systems "were very satisfied or somewhat satisfied with these features of their care."
In contrast, the three factors that women said "were least important in determining [their] overall satisfaction at both systems combined were attractiveness of the clinic, whether pain they felt after the procedure, if any, was addressed, and how any nausea they may have experienced was addressed," the researchers wrote.
Meanwhile, according to the authors, "the factors which women least commonly" said they were very satisfied with "were the same in both systems and included 'time spent waiting in clinic for procedure'" (43% at System A and 51% at System B), the waiting room's level of comfort (63% at both systems), and the ability to have a companion during the abortion procedure (66% at System A and 55% at System B).
"As expected, almost all (92%) women are satisfied with the care they receive for surgical abortion," the researchers wrote. They noted that "support provided by the physician is less important to patients receiving care ... than timing of the appointment and staff," but "the other important factor to women, the ability to get information and have questions answered, is dependent on both the staff and the provider."
According to the researchers, factors that did not substantially influence women's satisfaction included contraceptive counseling, the comfort of the waiting room area, the overall attractiveness of the clinic itself and the comfort of the recovery room. "These findings suggest that when funds are limited, it may be more prudent to spend resources on training staff rather than improving the appearance of the clinic and comfort of the waiting area," Tilles and colleagues wrote. Further, women reported that time spent waiting at the clinic was "not important in determining their overall satisfaction," which suggests that "women are willing to wait on the day of their abortion for the procedure and are satisfied as long as staff is courteous and questions are answered."
The researchers added, "Women in both systems were satisfied with their ability to bring a family member, spouse or friend to accompany them during the abortion procedure but less satisfied as compared to other factors." When considered with other research, "it appears that a clinic staff member who is with the patient from start to finish has a greater impact on overall satisfaction than another person (e.g., doula or family member) who is present during the procedure."
Tilles and colleagues compared their findings to a separate analysis that assessed an "observational cohort study primarily evaluating the efficacy and safety of advanced care practitioner provision of first trimester surgical abortion ... to determine which factors were related to women being more likely to report [their abortion experience] as 'excellent.'" That analysis found that "pain and waiting time were inversely related to rating the experience as excellent," whereas Tilles and colleagues' study found that "women were least likely to be very satisfied with waiting time as compared to other factors but that pain after the procedure was one of the least important factors related to the overall level of satisfaction." Tilles and colleagues wrote, "In general, the findings of [other study] provide context about the relationship of a few factors to an excellent abortion experience whereas our study focused on the importance of significantly more patient-care factors and determining which factors were most important in influencing satisfaction."
The researchers wrote that they want their findings to "enable providers to gain insight into which areas need more focus in the care of these patients." Noting "that the manner in which women are treated by clinical staff during the abortion process is one of the most important determinants of their overall satisfaction," the researchers urged clinic staff to "treat women undergoing abortion with dignity and respect."