EFFECT OF COUNSELING QUALITY ON PSYCHOLOGICAL OUTCOMES AFTER SECOND-TRIMESTER TERMINATION FOR PREGNANCY COMPLICATIONS

Purpose: To explore the relationship between shared decision making, decision satisfaction and quality of counseling and psychological outcomes (anxiety, grief and coping) after second-trimester termination for pregnancy complications.

Methods: We conducted a cross-sectional study of English-reading women in the United States aged 18 years and older who terminated a pregnancy in the second trimester for complications such as fetal anomalies or maternal illness. Participants were recruited through Facebook and other online support groups and asked about counseling experiences, stigma, demographic characteristics and psychosocial issues. Our primary independent variables for the analysis were shared decision making (SDM-9), decision satisfaction (modified Satisfaction with Decision Scale) and quality of counseling; dependent variables included anxiety (measured by the State-Trait Anxiety Inventory), grief (Perinatal Grief Scale) and coping (Impact of Event Scale). We used tests of correlation for unadjusted analyses and multivariable linear regression for adjusted analyses.

Results: Of the 164 respondents who completed the survey and met our inclusion criteria, 145 provided adequate data for this analysis. Respondents were mostly white, privately insured and well educated. Shared decision making and decision satisfaction scores were positively and strongly correlated (r= 0.7, p<0.0001). Coping and grief scores were also positively and strongly correlated (r=0.7, p<0.001). In the unadjusted analysis, shared decision making was negatively correlated with coping and grief (r=-0.26, p=0.009 and r=-0.19, p=0.05, respectively). Similarly, decision satisfaction was negatively correlated with coping and grief (r=-0.27, p=0.007 and r=-0.24, p=0.01, respectively). In the adjusted analysis, higher decision satisfaction was associated with lower grief and improved coping scores (p=0.02 and p=0.01, respectively) and higher shared decision making was associated with improved coping score (p=0.01).

Conclusions: Quality of counseling and shared decision making have a positive impact on psychological outcomes after pregnancy termination in the second trimester for pregnancy complications. This study builds on existing evidence that incorporating shared decision making and prioritizing decision satisfaction in clinical counseling can have positive health outcomes. Quality of counseling may be especially important in this setting given the sensitive nature of decisions regarding pregnancy termination for complications. These results speak to the importance of improving patient-centered counseling to ensure better emotional and psychological recovery for patients undergoing second-trimester termination for pregnancy complications.