Patient preferences for management of first-trimester incomplete spontaneous abortion

Abstract

Background: Approximately 15% of clinically recognized pregnancies end in miscarriage. The probabilities for successful outcome between expectant treatment and dilatation and curettage for management of many first-trimester incomplete spontaneous abortions are comparable. The goal of this study was to assess patient preferences for expectant treatment compared with dilatation and curettage, and the effect of physician recommendation on these preferences.

Methods: During individual telephone interviews, patients were read a case scenario and two treatment options. They were educated about the estimated risks, outcomes, and costs associated with each option. The patients then verbally completed a questionnaire assessing their likelihood of choosing each option, their reasons for their choice, and the effect of physician recommendation.

Results: Seventy-five women between the ages of 18 and 45 years, recruited from a university-affiliated family medicine clinic, were interviewed. Of these women, 27 had experienced spontaneous abortion (cases), and 48 had not (controls). Seventy-two percent of all participants (confidence interval 0.62-0.82) were likely or highly likely to choose expectant treatment, 23% of women rated the likelihood of choosing this option unlikely or highly unlikely, and 5% were uncertain. No significant difference existed between the case and control populations regarding choice of treatment (P = .566). One half of the women stated they would change their choice given a physician's recommendation (55% control, 40% case, P < .03)

Conclusions: Participants indicated a strong preference for expectant treatment, but gave physician recommendation a significant role in the final decision. Physicians need to offer both options to patients and consider individual patient preferences when making recommendations regarding management of first-trimester incomplete spontaneous abortion.