Surgical management of a loss of pregnancy in the first trimester: Patient experience and influencing factors, a prospective observational study

There is increasing interest in getting feedback from patients to highlight aspects of care in need of improvement. Healthcare providers have been working towards providing more holistic care, not only offering the effectiveness of “evidence-based medicine”, but also a medical experience that patients would find acceptable and beneficial. Obstetrics and gynaecology is a specialty that deals with intimacy [1], where a pelvic examination can be a source of anxiety, discomfort and awkwardness [2,3]. If this situation is not carefully controlled, physician risk losing the mutual trust that is essential to achieve quality of care. This highlights the necessity of assessing the care journey.

Miscarriages in the first trimester are a fairly common occurrence as one in four women will be affected before the age of 39 [4]. This makes it a relevant marker for an assessment of the care journey, as it is a situation where the patient meets with multiple medical teams, from the emergency department to the operating room and throughout their inpatient stay. In the past three decades, studies involving over 2,500 women have consistently shown an association between the loss of a pregnancy and short-term psychological morbidity [5]. This points to a dissatisfaction associated with experiencing a depressive episode in the three months following an early miscarriage [6]. Provision of inadequate care could therefore impact the “patient experience”. The emergency department is highly concerned by the patient experience considering that we note a gap between the violence of the event for the patient and its trivial nature, its normality for the medical staff [7]. Patients come with high expectations including their interaction with the care team [8]. Generally speaking, several qualitative studies report poor communication, a hostile environment and a lack of emotional support in the emergency department [9,10].

Over the past 20 years, studies aiming to assess the management of a lost pregnancy have focused on satisfaction towards the treatment itself [11], [12], [13], without taking into account the care journey as a whole. Similarly, assessing the “patient experience” was never a primary objective.

The Picker Patient Experience Questionnaire (PPE-15) is a validated tool used in several countries to assess the “patient experience” in various medical specialties [14], [15], [16]. It measures the quality of care based on seven dimensions [17] and is composed of 15 questions that can identify the main problems encountered in the care journey. It has never been to assess the “patient experience” in this context of lost of pregnancy.

Our objective was to conduct a multicentre, descriptive and analytical study to describe the “patient experience” regarding care provided during the surgical management of a loss of pregnancy in the first trimester, and to identify the factors influencing the patients’ experience, like the attempt of medical treatment before surgical management .

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