Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.647132
Title: Treatment choice for miscarriage : an evaluation of the psychological impact for women and their partners
Author: Kyte, Zoe Amelia
Awarding Body: University of Lincoln
Current Institution: University of Lincoln
Date of Award: 2009
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.647132  DOI: Not available
Keywords: C800 Psychology
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