“Every Person's Just Different”: Women's Experiences with Counseling for Early Pregnancy Loss Management

BackgroundWomen have strong preferences for their choice of early pregnancy loss (EPL) management. However, current practice patterns suggest that some women may not be offered counseling about the full range of management options. To develop a foundation for quality counseling about EPL treatment, we elicited patients' perspectives regarding their preferences and values for communication during this decision-making process.MethodsTwenty-one individual interviews were conducted with women who recently experienced EPL. Interviews discussed their experiences surrounding EPL diagnosis, counseling for and support during treatment decision making, and management outcomes, and concluded with questions seeking feedback on a decision tool. Interview transcripts were coded in an iterative and collaborative process by two authors, using constructivist grounded theory analysis.ResultsWomen in our study overwhelmingly preferred having options for EPL management rather than being prescribed a single treatment by their provider. Women reported a wide variety of personal priorities that influence decision making for EPL management. They valued providers who engaged in a balanced conversation about these priorities and medical recommendations. Participants stressed the importance of candid counseling about treatment options and expressed frustration with delayed news delivery for EPL diagnosis.ConclusionsA patient-centered approach to EPL management includes unbiased counseling about the full range of options available. Women may perceive communication during EPL diagnosis as a critical time to initiate these discussions. Women are often weighing personal priorities to make decisions about EPL management and use of a decision aid may offer a systematic approach to identifying women's preferences for treatment.