Phoebe Lyman

Factors Shaping Women's Pre-abortion Communication with Their Regular Gynecologic Care Providers

OBJECTIVE To understand womens experiences communicating with their regular gynecologic care provider about abortion decision making before obtaining an abortion at a dedicated abortion clinic. STUDY DESIGN Semistructured interviews were conducted with women presenting for first-trimester surgical abortion at a high-volume, hospital-based abortion clinic. Women were asked whether and why they did or did not discuss their abortion decision with their gynecologic care provider. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented. RESULTS Thirty women who obtained an abortion were interviewed. A majority of the 24 women who had a regular gynecologic care provider did not discuss their decision with that provider. Themes associated with not discussing their decision included: 1) perceiving that the discussion would not be beneficial, 2) expecting that gynecologic care providers do not perform abortions, 3) anticipating or experiencing logistical barriers, and 4) worrying about disrupting the patient-provider relationship. Women who did discuss their decision primarily did so because the pregnancy was diagnosed at the time of a previously scheduled appointment and generally did not believe that their provider performed abortions. CONCLUSION For many women, seeking counsel from a regular gynecologic provider before seeking an abortion may not afford a significant benefit. However, some women express concerns with regard to seeking abortion counselling from their regular provider. These concerns underscore the need for gynecologic providers to foster patient-provider relationships that allow women to feel comfortable discussing all aspects of their reproductive health.

Women's experiences with doula support during first-trimester surgical abortion: a qualitative study

OBJECTIVE To explore how doula support influences womens experiences with first-trimester surgical abortion. STUDY DESIGN We conducted semistructured interviews with women given the option to receive doula support during first-trimester surgical abortion in a clinic that uses local anesthesia and does not routinely allow support people to be present during procedures. Dimensions explored included (a) reasons women did or did not choose doula support; (b) key aspects of the doula interaction; and (c) future directions for doula support in abortion care. Interviews were transcribed, and computer-assisted content analysis was performed; salient themes are presented. RESULTS Thirty women were interviewed: 19 received and 11 did not receive doula support. Reasons to accept doula support included (a) wanting companionship during the procedure and (b) being concerned about the procedure. Reasons to decline doula support included (a) a sense of stoicism and desiring privacy or (b) not wanting to add emotion to this event. Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure, and most women who declined doula support subsequently regretted not having a doula. Many women endorsed additional roles for doulas in abortion care, including addressing informational and emotional needs before and after the procedure. CONCLUSION Women receiving first-trimester surgical abortion in this setting value doula support at the time of the procedure. This intervention has the potential to be further developed to help women address pre- and postabortion informational and emotional needs. IMPLICATIONS In a setting that does not allow family or friends to be present during the abortion procedure, women highly valued the presence of trained abortion doulas. This study speaks to the importance of providing support to women during abortion care. Developing a volunteer doula service is one approach to addressing this need, especially in clinics that otherwise do not permit support people in the procedure room or for women who do not have a support person and desire one.

“Because if we don’t talk about it, how are we going to prevent it?”: Lucidity, a narrative-based digital game about sexual violence

Abstract This paper describes the development and evaluation of an interactive, narrative-based, multimedia game to promote learning and communication about sexual violence and health topics. High school-aged participants created the game concept in a three-week workshop, after which assets were assembled and refined by a university-based game design lab. The outcome, Lucidity, was a multimedia game with a nonlinear narrative that led to two different outcomes based on player decisions. The narrative followed the life of one character, an African American woman named Zaria who remembers and grapples with a sexual assault from her past. The player discovers parts of the story by reading comics, watching videos, navigating interactive websites and playing short videogames. The final evaluation consisted of gameplay, a post-game focus group and follow-up interviews. Twenty-four young people participated in three focus group discussions (n = 9, n = 5, n = 10); 23 participated in the follow-up interviews. Salient themes identified in the focus group discussions included: overall approval of the game, the acquisition of new knowledge and minimal past exposure to conversations or education about sexual violence. At follow-up, almost all (n = 22) had initiated a conversation about sexual violence with a parent, peer and/or teacher. Lucidity succeeded in engaging young people and facilitating communication with adults and peers regarding sexual violence and other sexual health topics. Ultimately, a game-based intervention such as this represents a feasible approach for introducing issues of sexual violence, with potential for future implementation in educational settings.

Integrating Doulas Into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences

INTRODUCTION Balancing the need to provide individual support for patients and the need for an efficient clinic can be challenging in the abortion setting. This study explores physician, staff, and specially trained abortion doula perspectives on doula support, one approach to patient support. METHODS We conducted separate focus groups with physicians, staff members, and doulas from a high-volume, first-trimester aspiration abortion clinic with a newly established volunteer abortion doula program. Focus groups explored 1) abortion doula training, 2) program implementation, 3) program benefits, and 4) opportunities for improvement. Interviews were transcribed and computer-assisted content analysis was performed; salient findings are presented. RESULTS Five physicians, 5 staff members, and 4 abortion doulas participated in separate focus group discussions. Doulas drew on both their prior personal skills and experiences in addition to their abortion doula training to provide women with support at the time of abortion. Having doulas in the clinic to assist with womens emotional needs allowed physicians and staff to focus on technical aspects of the procedure. In turn, both physicians and staff believed that introducing doulas resulted in more patient-centered care. Although staff did not experience challenges to integrating doulas, physicians and doulas experienced initial challenges in incorporating doula support into the clinical flow. Staff and doulas reported exchanging skills and techniques that they subsequently used in their interactions with patients. DISCUSSION Physicians, clinic staff, and doulas perceive abortion doula support as an approach to provide more patient-centered care in a high-volume aspiration abortion clinic.

Factors Shaping Women’s Pre-abortion Communication with Members of Their Social Network

To understand women’s pre-abortion conversations with members of their social network about their abortion decision. Semi-structured interviews were conducted with women presenting for first-trimester surgical abortion at a high volume, hospital-based abortion clinic. Women were asked their reasons for discussing or not discussing abortion and responses received after disclosing their abortion decision. Interviews were transcribed and computer-assisted content analysis was performed. Salient themes are presented. Thirty women who obtained an abortion were interviewed. All but three spoke to at least one member of their social network about their abortion decision making. However, women were very selective about whom they spoke to regarding this decision. Reasons not to discuss their abortion decision included: concerns about judgment, desiring to maintain privacy, and certainty about their decision. Reasons to discuss their abortion decision included: seeking information about the procedure, needing guidance about their decision, wanting support for their decision to proceed with abortion. While many were concerned about being judged, most women who spoke about their decision experienced a positive response. Though most women in this study had at least one person to turn to for assistance with abortion decision making, many participants avoided confiding in some or all members of their social network about their abortion decision due to concerns of judgment and stigma.

Factors Shaping Womenʼs Preabortion Communication With Gynecologic Care Providers [182]

INTRODUCTION: Each year 1.2 million women undergo abortion services. The objective of this study was to understand decision-making regarding discussing the abortion decision with their gynecologic care provider. METHODS: We conducted semistructured interviews with women presenting for first-trimester surgical abortion at a high-volume, hospital-based clinic. Women were asked whether they discussed their abortion decision with their gynecologic care provider. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented. RESULTS: Thirty women who obtained an abortion were interviewed. Although six women discussed their decision with their gynecologic care provider, the majority (24) did not. Themes associated with not discussing the decision included: not having a regular health care provider, lapses in insurance status, certainty with the decision, a desire not to delay the procedure, and concerns that the discussion would negatively affect the doctor–patient relationship. Women who did discuss their decision generally did not believe that their health care provider performed abortions. Factors influencing this belief included: being referred by the health care provider to a standalone clinic, seeing the health care provider in a religiously affiliated clinic, and no prior exposure to abortion services within the health care providers clinical setting. Many women stated they would have liked to have their gynecologic care provider perform their abortion. CONCLUSION AND IMPLICATION: Women in this study either did not discuss their abortion decision with a gynecologic care provider or perceived that the health care provider would not perform their abortion, reflecting a discontinuity between routine womens health care and abortion care.

Womenʼs Experiences With Doula Support During First-Trimester Surgical Abortion: A Qualitative Study [183]

INTRODUCTION: Doula support, traditionally used during labor and delivery, has expanded into additional reproductive experiences, including miscarriage, adoption, and abortion. The objective of this study is to explore how doula support influences womens surgical abortion experiences. METHODS: We conducted semistructured interviews with women given the option to receive doula support during first-trimester surgical abortion. Dimensions explored included: 1) reasons women did or did not choose doula support; 2) key aspects of the doula interaction; and 3) future directions for doula support in abortion care. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented. RESULTS: Thirty women were interviewed: 19 opted for and 11 opted against doula support. Opting for doula support related to procedure concerns, prior abortion experiences, and positive associations with doulas from media or personal experiences. Doula support benefits included: distraction, physical support, coping with pain, and doulas as nurturers. Declining doula support stemmed from feeling that additional support was not needed, not wanting additional people present during the procedure, and feeling that doulas did not belong in abortion care. Most of these (n=7) women subsequently regretted not having a doula. Universally women favored greater doula interaction, primarily to address psychosocial concerns. Several women indicated that doulas would take more time for discussion and have a richer understanding of womens needs compared with physicians or other medical professionals. CONCLUSION AND IMPLICATION: Women receiving first-trimester surgical abortion value social support in the form of doulas. This intervention has the potential to be further developed to help women address postabortion psychosocial needs.

Abstract 1061: EZH2 expression in different subtypes of human breast cancer

Introduction: Cancer is characterized by aberrant patterns of expression of multiple genes believed to be due to not only genetic but also epigenetic changes. The epigenetic changes are communicated through chemical modifications, including modifications of histone proteins. For each histone, multiple histone-modifying enzymes have been discovered in mammals. We found that the expression of genes with histone modifications was highly predictable from the level of expression of the corresponding histone-modifying enzyme. Specifically, expression of genes displaying histone H3 K27 methylation was dependent on EZH2 expression. Method: We analyzed breast cancer tissue arrays for EZH2 expression. Tissue microarrays were constructed from 95 histologically confirmed breast cancer samples. To identify breast cancer subtypes, the tissues were evaluated for the expression of ER, PR, HER2, CK5/6 and EGFR. Staining with vimentin served as a control to monitor the quality of tissue fixation in archival tumors. Breast cancer subtypes were defined as luminal A (ER+ and/or PR+, HER2-), luminal B (ER+ and/or PR+, HER2+), basal-like (ER-, PR-, HER2-, CK5/6+, and/or EGFR+), HER2+/ER- (HER2+, ER-, PR-), and unclassified (negative for all five markers). EZH2 expression was measured by staining using an anti- EZH2 antibody (Invitrogen, cat. #18-7395). Staining quantification was performed independently by two pathologists. Results: The mean age of the patients was 56 years old (SD=15.6). 63.7% of the patients had estrogen receptor positive tumors, 50.6% had progesterone receptor positive tumors, and 21.2% had HER2+ tumors. The distribution of breast cancer subtypes is luminal A (58.9%), luminal B (6.3%), HER2+/ER- (4.2%), basal-like (28.5%), unclassified (2.1%). A majority of the patients had high grade tumors (46.0% grade II and 47.1% grade III). High EZH2 expression was associated with Her2+ and basal-like tumors (P Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1061. doi:1538-7445.AM2012-1061