Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion

Chloé Sharp; Sharla Biefeld; Rameet H. Singh; Lily Bayat

doi:10.29333/ajqr/15161

Chloé Sharp ¹ ^* , Sharla Biefeld ², Rameet H. Singh ¹, Lily Bayat ¹

More Detail

AM J QUALITATIVE RES, Volume 8, Issue 4, pp. 44-61

https://doi.org/10.29333/ajqr/15161

OPEN ACCESS 354 Views 172 Downloads

Download Full Text (PDF)

Abstract

A central component of a patient’s abortion experience is pain perception and optimization of pain management choices. Yet, data on patients’ experience of pain and their preferences regarding pain strategies are limited and tend to utilize solely quantitative data. This study utilized a qualitative thematic analysis to identify patient priorities, preferences, and expectations for pain management during first-trimester surgical abortion with nitrous oxide or oral sedation. Thirty-one patients seeking a first-trimester surgical abortion, self-selecting inhaled nitrous oxide (NO) (16 patients), or oral sedation (PO) with oxycodone and Ativan (15 patients) enrolled in this prospective cohort study. Participants provided demographic data, rated procedure pain on a 10 cm visual analog scale (VAS), and participated in semi-structured interviews. We analyzed qualitative data using a content analysis approach. Pre-procedure participants wanted a positive experience. Participants endorsed an ideal analgesic as having a quick onset of action, minimal side effects, no addiction potential, and being effective at reducing pain. After the procedure, there we start differences between priorities in NO and PO participants. NO participants valued the resumption of everyday activities, while PO participants desired ongoing anxiolysis. Anticipatory counseling often mitigated higher procedure pain and more medication side effects than anticipated. Participants emphasized that positive interactions with providers/staff significantly improved their abortion experience. Preemptive comprehensive counseling about procedure and analgesic effectiveness, along with providing options for analgesia, will facilitate an affirmative and patient-centered abortion experience.

Keywords: Nitrous oxide, pain management, patient expectations, patient preferences, surgical abortion

References

Allen, R. H., Fitzmaurice, G., Lifford, K. L., Lasic, M., & Goldberg, A. B. (2009). Oral compared with intravenous sedation for first-trimester surgical abortion: A randomized controlled trial. Obstetrics and Gynecology, 113(2–1), 276–283. https://doi.org/10.1097/AOG.0b013e3181938758
Allen, R. H., Fortin, J., Bartz, D., Goldberg, A. B., & Clark, M. A. (2012). Women’s preferences for pain control during first-trimester surgical abortion: A qualitative study. Contraception, 85(4), 413–418. https://doi.org/10.1016/j.contraception.2011.08.019
Altshuler, A. L., Ojanen-Goldsmith, A., Blumenthal, P. D., & Freedman, L. R. (2017). A good abortion experience: A qualitative exploration of women’s needs and preferences in clinical care. Social Science & Medicine, 191, 109–116. https://doi.org/10.1016/j.socscimed.2017.09.010
Anderson, K. O., Green, C. R., & Payne, R. (2009). Racial and ethnic disparities in pain: Causes and consequences of unequal care. The Journal of Pain, 10(12), 1187–1204. https://doi.org/10.1016/j.jpain.2009.10.002
Barr-Walker, J., Jayaweera, R. T., Ramirez, A. M., & Gerdts, C. (2019). Experiences of women who travel for abortion: A mixed methods systematic review. PLOS ONE, 14(4), Article e0209991. https://doi.org/10.1371/journal.pone.0209991
Bayer, L. L., Edelman, A. B., Fu, R., Lambert, W. E., Nichols, M. D., Bednarek, P. H., Miller, K., & Jensen, J. T. (2015). An evaluation of oral midazolam for anxiety and pain in first-trimester surgical abortion: A randomized controlled trial. Obstetrics & Gynecology, 126(1), 37–46. https://doi.org/10.1097/AOG.0000000000000913
Bearak, J., Popinchalk, A., Ganatra, B., Moller, A.-B., Tunçalp, Ö., Beavin, C., Kwok, L., & Alkema, L. (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion: Estimates from a comprehensive model for 1990–2019. The Lancet Global Health, 8(9), e1152–e1161. https://doi.org/10.1016/S2214-109X(20)30315-6
Becker, S., Fuchs, X., Schakib‐Ekbatan, K., & Schweiker, M. (2020). What does “moderate pain” mean? Subgroups holding different conceptions of rating scales evaluate experimental pain differently. European Journal of Pain, 24(3), 625–638. https://doi.org/10.1002/ejp.1514
Berglas, N. F., Battistelli, M. F., Nicholson, W. K., Sobota, M., Urman, R. D., & Roberts, S. C. M. (2018). The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review. PloS One, 13(1), Article e0190975. https://doi.org/10.1371/journal.pone.0190975
Bradfield, Z., Rose, M. S., Freeman, N., Leefhelm, E., Wood, J., & Barnes, C. (2023). Women’s perspectives of nitrous oxide for labour and procedural analgesia: A prospective clinical audit and cross-sectional study. “It’s the best thing.” Women and Birth, 36(6), 529–537. https://doi.org/10.1016/j.wombi.2023.06.007
Bronfenbrenner, U. (1994). Ecological models of human development. In M. Gauvain & M. Cole (Eds.), Readings on the development of children (2nd ed., pp. 37–43). Oxford.
Clark, S., Krishna, U., Kallenbach, L., Mandlekar, A., Raote, V., & Ellertson, C. (2002). Women’s preferences for general or local anesthesia for pain during first trimester surgical abortion in India. Contraception, 66(4), 275–279. https://doi.org/10.1016/S0010-7824(02)00348-7
Conti, J. A., Lerma, K., Shaw, K. A., & Blumenthal, P. D. (2016). Self-administered lidocaine gel for pain control with first-trimester surgical abortion: A randomized controlled trial. Obstetrics & Gynecology, 128(2), 297–303. https://doi.org/10.1097/AOG.0000000000001532
Dehlendorf, C., Harris, L. H., & Weitz, T. A. (2013). Disparities in abortion rates: A public health approach. American Journal of Public Health, 103(10), 1772–1779. https://doi.org/10.2105/AJPH.2013.301339
Duros, S., Joueidi, Y., Nyangoh Timoh, K., Boyer, L., Lemeut, P., Tavenard, A., Laviolle, B., Levêque, J., & Lavoué, V. (2018). A prospective study of the frequency of severe pain and predictive factors in women undergoing first-trimester surgical abortion under local anaesthesia. European Journal of Obstetrics & Gynecology and Reproductive Biology, 221, 123–128. https://doi.org/10.1016/j.ejogrb.2017.12.024
Georgsson, S., & Carlsson, T. (2019). Pain and pain management during induced abortions: A web-based exploratory study of recollections from previous patients. Journal of Advanced Nursing, 75(11), 3006–3017. https://doi.org/10.1111/jan.14132
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap): A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Hellams, A., Sprague, T., Saldanha, C., & Archambault, M. (2018). Nitrous oxide for labor analgesia. JAAPA: Official Journal of the American Academy of Physician Assistants, 31(1), 41–44. https://doi.org/10.1097/01.JAA.0000527700.00698.8c
Hennink, M. M., Kaiser, B. N., & Marconi, V. C. (2017). Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough? Qualitative Health Research, 27(4), 591–608. https://doi.org/10.1177/1049732316665344
Jacobson, L. E., Saavedra-Avendano, B., Fuentes-Rivera, E., Schiavon, R., & Darney, B. G. (2022). Travelling for abortion services in Mexico 2016–2019: Community-level contexts of Mexico City public abortion clients. BMJ Sexual & Reproductive Health, 48(e1), e81–e87. https://doi.org/10.1136/bmjsrh-2021-201079
Jensen, M. P., Miller, L., & Fisher, L. D. (1998). Assessment of pain during medical procedures: A comparison of three scales. The Clinical Journal of Pain, 14(4), 343–349. https://doi.org/10.1097/00002508-199812000-00012
Keefe-Oates, B., Makleff, S., Sa, E., Forero, L. J., Mendoza, D., Olaya, M. A., Avila Morales, F., Friedman, J., & Baum, S. E. (2020). Experiences with abortion counselling in Mexico City and Colombia: Addressing women’s fears and concerns. Culture, Health & Sexuality, 22(4), 413–428. https://doi.org/10.1080/13691058.2019.1604995
LaRoche, K. J., & Foster, A. M. (2020). “It gives you autonomy over your own choices”: A qualitative study of Canadian abortion patients’ experiences with mifepristone and misoprostol. Contraception, 102(1), 61–65. https://doi.org/10.1016/j.contraception.2020.04.007
Likis, F. E., Andrews, J. C., Collins, M. R., Lewis, R. M., Seroogy, J. J., Starr, S. A., Walden, R. R., & McPheeters, M. L. (2014). Nitrous oxide for the management of labor pain: A systematic review. Anesthesia & Analgesia, 118(1), 153–167. https://doi.org/10.1213/ANE.0b013e3182a7f73c
Liu, S. M., & Shaw, K. A. (2021). Pain management in outpatient surgical abortion. Current Opinion in Obstetrics & Gynecology, 33(6), 440–444. https://doi.org/10.1097/GCO.0000000000000754
Makleff, S., Wilkins, R., Wachsmann, H., Gupta, D., Wachira, M., Bunde, W., Radhakrishnan, U., Cislaghi, B., & Baum, S. E. (2019). Exploring stigma and social norms in women’s abortion experiences and their expectations of care. Sexual and Reproductive Health Matters, 27(3), 50–64. https://doi.org/10.1080/26410397.2019.1661753
McLemore, M. R., Desai, S., Freedman, L., James, E. A., & Taylor, D. (2014). Women know best—Findings from a thematic analysis of 5,214 surveys of abortion care experience. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 24(6), 594–599. https://doi.org/10.1016/j.whi.2014.07.001
Micks, E., Renner, R. M., Jensen, J., Nichols, M., Bednarek, P., Beckley, E., & Edelman, A. (2012). An evaluation of hydrocodone/acetaminophen for pain control in first-trimester surgical abortion. Contraception, 86(3), 295. https://doi.org/10.1016/j.contraception.2012.05.040
Moayedi, G., & Tschann, M. (2018). Pain management for first-trimester uterine aspiration. Obstetrical & Gynecological Survey, 73(3), 174–181. https://doi.org/10.1097/OGX.0000000000000544
Nash, E., & Cross, L. (2022, April 19). 26 States are certain or likely to ban abortion without Roe: Here’s which ones and why. Guttmacher Institute. https://www.guttmacher.org/article/2021/10/26-states-are-certain-or-likely-ban-abortion-without-roe-heres-which-ones-and-why
Nguyen, M., Cartwright, A. F., & Upadhyay, U. D. (2023). Fear of procedure and pain in individuals considering abortion: A qualitative study. Patient Education and Counseling, 108, Article 107611. https://doi.org/10.1016/j.pec.2022.107611
Oviedo, J., & Denny, C. C. (2023). Pain management in abortion care. Clinical Obstetrics & Gynecology, 66(4), 665–675. https://doi.org/10.1097/GRF.0000000000000807
Peterson, S. F., & Lerma, K. (2020). Advances in abortion care technology and management. Current Opinion in Obstetrics & Gynecology, 32(6), 424–430. https://doi.org/10.1097/GCO.0000000000000654
Rader, B., Upadhyay, U. D., Sehgal, N. K. R., Reis, B. Y., Brownstein, J. S., & Hswen, Y. (2022). Estimated travel time and spatial access to abortion facilities in the US before and after the Dobbs v Jackson Women’s Health decision. JAMA, 328(20), Article 2041. https://doi.org/10.1001/jama.2022.20424
Rahimi, S., & Khatooni, M. (2024). Saturation in qualitative research: An evolutionary concept analysis. International Journal of Nursing Studies Advances, 6, Article 100174. https://doi.org/10.1016/j.ijnsa.2024.100174
Reingold, R. B., & Gostin, L. O. (2022). The leaked supreme court ruling opinion: Implications for abortion access. JAMA, 328(1), 13–14. https://doi.org/10.1001/jama.2022.10204
Renner, R. M., Jensen, J. T., Nichols, M. D., & Edelman, A. B. (2010). Pain control in first-trimester surgical abortion: A systematic review of randomized controlled trials. Contraception, 81(5), 372–388. https://doi.org/10.1016/j.contraception.2009.12.008
Renner, R. M., Nichols, M. D., Jensen, J. T., Li, H., & Edelman, A. B. (2012). Paracervical block for pain control in first-trimester surgical abortion: A randomized controlled trial. Obstetrics & Gynecology, 119(5), 1030–1037. https://doi.org/10.1097/AOG.0b013e318250b13e
Rosen, M. (2002). Nitrous oxide for relief of labor pain: A systematic review. American Journal of Obstetrics and Gynecology, 186(5), S110–S126. https://doi.org/10.1067/mob.2002.121259
Ross, L. J. (2017). Reproductive justice as intersectional feminist activism. Souls, 19(3), 286–314. https://doi.org/10.1080/10999949.2017.1389634
Singh, R. H., Espey, E., Carr, S., Pereda, B., Ogburn, T., & Leeman, L. (2015). Nitrous oxide for pain management of first trimester surgical abortion: A randomized controlled pilot study. Contraception, 91(2), 164–166. https://doi.org/10.1016/j.contraception.2014.09.013
Singh, R. H., Montoya, M., Espey, E., & Leeman, L. (2017). Nitrous oxide versus oral sedation for pain management of first-trimester surgical abortion: A randomized study. Contraception, 96(2), 118–123. https://doi.org/10.1016/j.contraception.2017.06.003
Stevenson, A. J. (2021). The pregnancy-related mortality impact of a total abortion ban in the United States: A research note on increased deaths due to remaining pregnant. Demography, 58(6), 2019–2028. https://doi.org/10.1215/00703370-9585908
Taylor, D., Postlethwaite, D., Desai, S., James, E. A., Calhoun, A. W., Sheehan, K., & Weitz, T. A. (2013). Multiple determinants of the abortion care experience: From the patient’s perspective. American Journal of Medical Quality: The Official Journal of the American College of Medical Quality, 28(6), 510–518. https://doi.org/10.1177/1062860613484295
Vallejo, M. C., & Zakowski, M. I. (2019). Pro-con debate: Nitrous oxide for labor analgesia. BioMed Research International, 2019, 1–12. https://doi.org/10.1155/2019/4618798
White, K. O., Jones, H. E., Lavelanet, A., Norman, W. V., Guilbert, E., Lichtenberg, E. S., & Paul, M. (2019). First-trimester aspiration abortion practices: A survey of United States abortion providers. Contraception, 99(1), 10–15. https://doi.org/10.1016/j.contraception.2018.08.011
Zaręba, K., Herman, K., Kołb-Sielecka, E., & Jakiel, G. (2021). Abortion in countries with restrictive abortion laws: Possible directions and solutions from the perspective of Poland. Healthcare, 9(11), Article 1594. https://doi.org/10.3390/healthcare9111594
Zhuang, Y., Zhu, X., & Huang, L.-L. (2010). The effect of phloroglucinol on pain in first-trimester surgical abortion: A double-blind randomized controlled study. Contraception, 81(2), 157–160. https://doi.org/10.1016/j.contraception.2009.07.009

Citation

Sharp, C., Biefeld, S., Singh, R. H., & Bayat, L. (2024). Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion. American Journal of Qualitative Research, 8(4), 44-61. https://doi.org/10.29333/ajqr/15161

Sharp, C., Biefeld, S., Singh, R. H., and Bayat, L. (2024). Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion. American Journal of Qualitative Research, 8(4), pp. 44-61. https://doi.org/10.29333/ajqr/15161

Sharp C, Biefeld S, Singh RH, Bayat L. Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion. AM J QUALITATIVE RES. 2024;8(4), 44-61. https://doi.org/10.29333/ajqr/15161

Sharp, Chloé, Sharla Biefeld, Rameet H. Singh, and Lily Bayat. "Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion". American Journal of Qualitative Research 2024 8 no. 4 (2024): 44-61. https://doi.org/10.29333/ajqr/15161

Sharp, Chloé et al. "Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion". American Journal of Qualitative Research, vol. 8, no. 4, 2024, pp. 44-61. https://doi.org/10.29333/ajqr/15161

Sharp C, Biefeld S, Singh RH, Bayat L. Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion. AM J QUALITATIVE RES. 2024;8(4):44-61. https://doi.org/10.29333/ajqr/15161