Consent for Trainee Participation in Abortion Care: A Qualitative Study of Patient Experiences & Preferences in the United States

Consent for Trainee Participation in Abortion Care: A Qualitative Study of Patient Experiences & Preferences in the United States
Lara Crystal-Ornelas, Shashi Sarnaik, Shokoufeh Dianat, Christine Dehlendorf, Kelsey Holt
Contraception, 8 February 2023
Abstract
Objectives
Abortion training for clinicians is crucial to ensure patients’ future access to full spectrum reproductive health care. Given the complex sociopolitical context of abortion, consent to allow a trainee’s involvement in abortion care requires careful attention to avoid harm to patients while also ensuring adequate clinician training for the future provision of care. In order to inform the development of patient-centered recommendations, we assessed patient experiences and preferences around consent for trainee participation during abortion care.
Study design
We interviewed participants who received abortion care at sites with medical trainees in the United States (US). We conducted interviews via zoom (video-off) between August 2021 and January 2022. We audio-recorded and transcribed the interviews. We coded transcripts using NVivo software and analyzed inductively using thematic analysis.
Results
Twenty-four (n=24) participants reflected a diverse range of socio-demographics as well as location of abortion service. Some reported experiences of coercion related to trainee involvement, ranging from subtle to overt. Participants preferred consent for trainee involvement in abortion care be a process outside the procedure room, while clothed, without the trainer or trainee present to allow for time to consider options without pressure to say yes.
Conclusions
Patient-centered approaches to seeking consent for trainee involvement in abortion care must reduce potential for coercion. A standardized consent before the procedure room by a trained staff member without the trainer or trainee present can help prioritize patient autonomy. Understanding care team member roles and upholding confidentiality and privacy are paramount to patients feeling safe with trainees present.