Abortion in First Trimester Clinical Trial
Official title:
Delivery of Audiovisual Information on Early Medical Abortion to Women in Europe Via Digital Technology: is it Acceptable and Informative?
The majority of abortions in the United Kingdom (UK) are performed before 9 weeks (63 days)
gestation using a method known as Early Medical Abortion (EMA). EMA involves an assessment
visit and provision of two types of medication .
The assessment visit usually involves Ultrasound to confirm gestation, detailed personal
history, safeguarding assessment and contraception planning, before arranging treatment and
follow up.
The process is long and lots of information is given to women attending the service. In NHS
Lothian (National Health Service, Lothian Health Board), the average appointment length for
combined assessment and provision of the first part of treatment is 3 hours.
Despite how common abortion is ( 1 in 3), many women presenting for abortion care are not
aware of what the procedure will involve. This may in part to the social stigma surrounding
abortion and unintended pregnancy in general. This stigma can in turn result in feelings of
anxiety and shame about the decision to terminate a pregnancy.
There is evidence that short videos shown to patients prior to abortion or contraception
consultations can improve their ability to recall information and can make them feel more
confident about the procedure.
Additionally, abortion care providers have found patients who have seen videos to be better
prepared and informed and this allows consultations to progress more easily and allow greater
time for discussion of contraceptive methods.
We have prepared a video approximately 3 minutes in length to provide information about EMA.
It summarises the process described above using simple language and animated characters. The
video has been translated into French, Portuguese and Swedish and has been adapted to reflect
subtle differences in practice and law in these countries. We have partners in services in
these three countries who will be conducting the trial there in accordance with this protocol
and their own local ethics and clinical governance requirements.
Despite abortion being a common medical procedure, many women do not have access to good
quality, reliable information about it. This may stem from the stigma and shame surrounding
the procedure leading to less community knowledge and experience sharing compared to other
medical conditions, for example diabetes or heart disease.
Lack of knowledge and understanding about a medical procedure can cause anxiety, distress and
confusion when seeing a healthcare professional, which in turn can prolong consultations.
By introducing the short video animation, we are hoping that this will give the women
attending the service a basic level of knowledge about Early Medical Abortion, reduce the
anxiety and worry they are experiencing by informing them, and make them feel more confident
and clear during their consultations.
It has been shown in other studies that short videos in contraception and abortion
consultations can have this impact, but a randomised control trial methodology has never been
applied to this intervention.
In a standard initial Early Medical Abortion visit a patient will experience the following
Patient Journey:
1. Arrival and registration
2. Waiting for appointment in waiting room
3. Ultrasound scan to determine gestation
4. Self taken vulvovaginal swab for Chlamydia and Gonorrhoea screening
5. Blood tests for : HIV, Syphilis, Full Blood Count, Blood Group
6. Return to the waiting room
7. Assessment consultation with healthcare professional (i.e. Specialist Nurse or Doctor)
8. Return to the waiting room
9. Treatment Consultation: to receive 'first part' of treatment i.e. Mifepristone and dates
for 'second part' 24-48 hours later.
10. Leave department
In the study, the above will happen, however patients will be given a participant information
sheet (at step 1 above )when they arrive in department to register. At Step 6, when the
patient has returned to the waiting room, eligible patients will be approached and asked if
they would like to participate and if so will be randomised to 'standard of care' or
'intervention' (i.e. the video). They will resume the Patient Journey above and will again be
approached at Step 8 or Step 10 to complete the short questionnaire.
For the questionnaire: a single researcher will record, on a standard proforma, what
information the subject had taken from the consultation and its accuracy, and the overall
acceptability of the consultation using a Likert scale to quantify descriptors such as
'helpful', 'informative', 'understandable', 'impersonal', 'sympathetic' 'unsympathetic' etc.
The number of women declining to participate in the study would be recorded .
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