PDF(Pubmed)
Abstract：
UNASSIGNED: Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men\'s health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases.
UNASSIGNED: Fifteen vasectomy providers belonging to the global Vasectomy Network google group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20.
UNASSIGNED: Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy.
UNASSIGNED: Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.
UNASSIGNED: Fifteen vasectomy providers belonging to the global Vasectomy Network google group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20.
UNASSIGNED: Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy.
UNASSIGNED: Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.
摘要：
■男性绝育，或者输精管切除术,在预防怀孕方面的有效率为99.9%，并发症的风险低于2%。尽管疗效很高,低风险,低成本,和输精管切除术的性别平等利益，2019年,全球只有2%的女性报告说,她们和她们的伴侣依靠输精管结扎术作为避孕方法.一般情况下，医疗保健提供者既可以促进男性健康，也可以成为男性健康的障碍，也可能在输精管切除术中。这项研究旨在描述经验丰富的输精管切除术提供者在评估复杂病例中的患者候选人资格时的决策依据。
■来自七个国家/地区的全球输精管切除术网络Google小组的15个输精管切除术提供商使用半结构化深度访谈指南参加了在线访谈。供应商被问及他们的输精管切除术培训，他们提供输精管切除术的原因，他们面临的具有挑战性的案例，以及用于管理具有挑战性的案例的方法。小插图被用来进一步引出决策理由。使用MAXQDA20进行主题分析。
■提供者的决策是基于确保患者了解情况，能够同意，并确定他们选择进行输精管结扎术。一旦这些基本条件得到满足，提供者通过他们的培训过滤了患者的特征，法律和政策,社会文化规范，经验,和同行影响，以产生成本效益分解。根据成本效益分析，在确定输精管结扎术患者的候选资格时,提供者决定是否更加权衡自主性或非恶意.
■尽管临床最佳实践促进患者自主性优先于非恶意治疗，在输精管结扎术患者的候选资格评估中,一些提供者继续权衡非恶意而非自主性.在提供者被认为后悔风险较高的情况下，非恶意行为尤其优先。这项研究的结果表明，输精管结扎术提供者的培训应强调在共同决策和以患者为中心的护理中基于证据的最佳实践，以促进输精管结扎术的规定，以尊重患者的自主权和权利。
■来自七个国家/地区的全球输精管切除术网络Google小组的15个输精管切除术提供商使用半结构化深度访谈指南参加了在线访谈。供应商被问及他们的输精管切除术培训，他们提供输精管切除术的原因，他们面临的具有挑战性的案例，以及用于管理具有挑战性的案例的方法。小插图被用来进一步引出决策理由。使用MAXQDA20进行主题分析。
■提供者的决策是基于确保患者了解情况，能够同意，并确定他们选择进行输精管结扎术。一旦这些基本条件得到满足，提供者通过他们的培训过滤了患者的特征，法律和政策,社会文化规范，经验,和同行影响，以产生成本效益分解。根据成本效益分析，在确定输精管结扎术患者的候选资格时,提供者决定是否更加权衡自主性或非恶意.
■尽管临床最佳实践促进患者自主性优先于非恶意治疗，在输精管结扎术患者的候选资格评估中,一些提供者继续权衡非恶意而非自主性.在提供者被认为后悔风险较高的情况下，非恶意行为尤其优先。这项研究的结果表明，输精管结扎术提供者的培训应强调在共同决策和以患者为中心的护理中基于证据的最佳实践，以促进输精管结扎术的规定，以尊重患者的自主权和权利。
