"At the End of the Day it's Their choice": An Exploratory Qualitative Study of Pregnancy Options Counseling

This study's purpose was to explore the current models and approaches of pregnancy options counseling across three types of agency settings in a Northeastern state. Additionally, this study aimed to determine if individuals who receive pregnancy options counseling obtained medically factual, non-directive, and non-biased information needed to make informed decisions related to their pregnancy decisions. Using qualitative research methodology, semi-structured interviews were conducted with 10 participants across three different agency settings in one state in the Northeastern United States. Results indicated agencies shared a definition of pregnancy options counseling. Outcomes also suggest agency type impacted how pregnancy options counseling was delivered, as variations were found in education provided to patients. Lastly, the interviews imply no standardized model or training for pregnancy options counselors is currently being used.

The practice of pregnancy options counseling in social service and healthcare settings in the United States: a systematic literature review

INTRODUCTION

The purpose of this systematic literature was to summarize the literature on pregnancy options counseling for women and patients who experience an unintended pregnancy across healthcare and social service settings.

METHODS

We conducted a systematic literature review using the PRISMA Checklist. Following the literature search of 8 electronic databases, we used a three-stage search process to screen articles for inclusion.

RESULTS

A total of 20 peer-reviewed articles met the inclusion criteria for this study. Half (n = 10) of the articles reviewed were empirical studies utilizing quantitative or qualitative methodology while the other half (n = 10) were conceptual or non-empirical. The articles affirmed a shared definition of pregnancy options counseling, but terminology differences were noted over time. Lastly, variations of intervention practices appeared across practice settings, with referral practice variations being the most notable.

CONCLUSION

Pregnancy options counseling practices varied across settings, suggesting patients who received this intervention may not have accessed equitable or ethical care.

Religious Support Moderates the Long Reach of Adverse Childhood Events on Physical Health in Middle to Late Adulthood

Adverse childhood experiences are associated with impaired physical health in adulthood. Using data from the Midlife in the United States survey (N = 4041), this study examined whether four dimensions of religiosity moderated the long-term detrimental effects of early adversity on three distinct aspects of adult physical health (self-rated health, functional limitations, and shortness of breath). Regression analyses showed that religious support buffered the effect of childhood adversity on physical health, but religious identification, private religious practice, or religious service attendance did not. Results imply that interventions aimed at increasing religious support can be effective decades after the adverse experiences took place.

The Preimplantation Psychosocial Evaluation and Prediction of Clinical Outcomes During Mechanical Circulatory Support: What Information Is Most Prognostic?

BACKGROUND

Psychosocial evaluations are required for long-term mechanical circulatory support (MCS) candidates, no matter whether MCS will be destination therapy (DT) or a bridge to heart transplantation. Although guidelines specify psychosocial contraindications to MCS, there is no comprehensive examination of which psychosocial evaluation domains are most prognostic for clinical outcomes. We evaluated whether overall psychosocial risk, determined across all psychosocial domains, predicted outcomes, and which specific domains appeared responsible for any effects.

METHODS

A single-site retrospective analysis was performed for adults receiving MCS between April 2004 and December 2017. Using an established rating system, we coded psychosocial evaluations to identify patients at low, moderate, or high overall risk. We similarly determined risk within each of 10 individual psychosocial domains. Multivariable analyses evaluated whether psychosocial risk predicted clinical decisions about MCS use (DT versus bridge), and postimplantation mortality, transplantation, rehospitalization, MCS pump exchange, and standardly defined adverse medical events (AEs).

RESULTS

In 241 MCS recipients, greater overall psychosocial risk increased the likelihood of a DT decision (odds ratio, 1.76; P = 0.017); and postimplantation pump exchange and occurrence of AEs (hazard ratios [HRs] ≥ 1.25; P ≤ 0.042). The individual AEs most strongly predicted were cardiac arrhythmias and device malfunctions (HRs ≥ 1.39; P ≤ 0.032). The specific psychosocial domains predicting at least 1 study outcome were mental health problem severity, poorer medical adherence, and substance use (odds ratios and HRs ≥ 1.32; P ≤ 0.010).

CONCLUSIONS

The psychosocial evaluation predicts not only clinical decisions about MCS use (DT versus bridge) but important postimplantation outcomes. Strategies to address psychosocial risk factors before or soon after implantation may help to reduce postimplantation clinical risks.