Treatment choice for miscarriage: an evaluation of the psychological impact for women and their partners

Kyte, Zoe Amelia (2009) Treatment choice for miscarriage: an evaluation of the psychological impact for women and their partners. DClinPsy thesis, University of Lincoln.

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Abstract

Background: Currently, standard practice is to allocate women to a particular
treatment for miscarriage; most commonly surgical. The alternative of offering
women a choice in their treatment is controversial due to pre-conceptions
around their potential for distress. However, exploration of the psychological
outcomes of women and their partners when given a choice may offer new
insights into the validity of existing ideas.
Methods: A non-randomised longitudinal design was used. Eighty-one
women attending an Early Pregnancy Assessment Unit completed a 14-day
diary following their miscarriage, including factors contributing to their
treatment choice, the General Health Questionnaire (GHQ-12), the
Spielberger Trait Anxiety Inventory (STAI), and rating scales for pain and
bleeding. Women and their partners were also sent follow-up questionnaires
at six weeks, including the GHQ-12, the Impact of Events Scale (IES) and
evaluation of their treatment. Quantitative data was analysed using nonparametric
analysis due to data not conforming to gaussian distributions and
unequal sample sizes across treatment groups. Analyses included Wilcoxon
Signed Rank tests to explore changes over time on specific measures,
Kruskal Wallis tests to explore differences between treatment groups, Mann
Whitney Tests to locate specific post-hoc group differences, and chi-square
tests to examine treatment choices and factors affecting choice. This analysis
was complimentary to further qualitative theme analysis of additional factors
women freely described as important when making their choice in treatment.
2008 Research Project Report. UoL: 06060037, UoN: 4059140 Page 8 of 233
Results: 43.2% of women chose surgical treatment, with choice being
influenced by being frightened of seeing the miscarriage. Different factors
were influential to women’s choices across the other treatment options.
Women expressed a range of factors that contributed to their choice, including
desire for a speedy return to normality, past experience, desire for the most
natural option, family and home support, impact on family, staff advice, fear of
pain, bleeding and complications, wanting to avoid hospital, wanting control,
and seeking an explanation for their miscarriage. STAI and GHQ-12 scores
did not significantly differ according to treatment choice. Levels of pain also
failed to discriminate between the treatment groups. However, women
receiving expectant treatment reported greater amounts of bleeding across
days one to four compared to those receiving surgical treatment. Furthermore,
scores on the IES were significantly different across groups, with the medical
outpatient group reporting lower scores than all others, and the surgical group
reporting lower scores compared to the medical inpatient group. Scores
across all measures were not significantly different when women and their
partners were compared, although a significantly greater proportion of
partners reached “caseness” on the GHQ-12 in the group of women receiving
surgical treatment,
Conclusions: The largest proportion of women chose surgical as their
preferred treatment, with different choices being influenced by different
factors. Whilst anxiety and non-psychotic symptoms do not appear to differ
depending on the treatment women received, results suggest those women
choosing medical outpatient experienced less trauma as a result compared to
2008 Research Project Report. UoL: 06060037, UoN: 4059140 Page 9 of 233
all other treatment groups. This was also true but to a lesser extent for women
choosing surgical treatment (who also reported lower levels of bleeding
compared to those receiving expectant treatment). Across measures, whilst
the level of psychological distress was comparable between women and their
partners, men appeared to experience greater distress when their partner had
received surgical treatment.

Additional Information:Submitted in part fulfilment of the requirements for the Doctorate in Clinical Psychology
Keywords:Miscarriage
Subjects:C Biological Sciences > C800 Psychology
Divisions:College of Social Science > School of Psychology
ID Code:17467
Deposited On:18 May 2015 14:39

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