背景:终止妊娠(TOP)并不少见。各司法管辖区的可用性差异很大;然而,立法之外的其他体制程序也会影响护理和服务的提供。本研究旨在研究机构流程在提供TOP服务中可以发挥的作用,在TOP在所有妊娠均合法的司法管辖区(维多利亚,澳大利亚)。根据《2008年堕胎法改革法案》,24周后的TOP需要两名医生的批准。然而,在维多利亚,提供24周后的TOP的医院通常要求这些病例在提供服务之前还要到终止审查委员会进行评估。这些委员会在立法中没有规定。关于这些委员会及其运作方式的信息很少,公众可获得的信息也很少。
方法:要追踪历史,函数,以及这些委员会的决策过程,我们进行了定性访谈研究。我们采访了参与这些委员会的27名医疗保健专业人员。我们使用目的性抽样从10家医院的一系列专业中获得观点。访谈被逐字转录,识别删除的细节并进行归纳主题分析.
结果:这里,我们报告了与会者描述的委员会的三项主要职能。功能是保护:(1)外观;(2)内在功能;和/或,(3)服务用户。功能(1)可能意味着保护医院的声誉,通过“先驱太阳报测试”-《先驱太阳报》的读者是否可以接受TOP,小报——用作启发式。功能(2)与医院内的后勤有关,并保护医疗保健专业人员的心理健康和个人声誉。最终功能(3)与确保患者接受高标准的护理有关。
结论:这些委员会的主要职能似乎是在这些程序引起争议和污名化的情况下保护医院和临床医生。这项研究的结果从所涉及的医疗保健专业人员的角度进一步阐明了在以后的妊娠中提供TOP的过程。医院已经建立了立法要求之外的机构程序。这些发现强调了患者及其提供者在妊娠后期寻求TOP时面临的其他挑战。
堕胎很难。在维多利亚,澳大利亚,根据法律,在怀孕期间的任何时候都允许堕胎-尽管在怀孕超过24周后,需要两名医生的批准。然而,维多利亚州提供晚期堕胎的医院需要超过两名医生的批准。医院已经成立了委员会,审查每个病例,并决定医院是否会提供堕胎。关于这些委员会的信息并不多-我们不知道它们存在的确切原因,它们是为了什么,或者它们是如何工作的。为了找出答案,我们采访了参与这些委员会的医生和其他医疗保健专业人员(如助产士)。在本文中,我们报告了这些人为什么委员会存在以及他们的目的。有三个主要原因。该委员会的第一个目的是使医院不会因进行这些晚期流产而在报纸上或医院外的其他人受到批评。第二个原因是帮助和保护医院内的人。例如,有一个委员会意味着医生不必自己做决定。人们还说,委员会会考虑员工的感受。第三个原因是为了让医院提供最好的护理,他们可以在未来继续提供晚期堕胎。通过这项研究,我们发现了一些我们以前没有的关于这些委员会的更重要的信息。我们的发现表明,重要的不仅仅是法律-其他事情也会影响您是否可以堕胎。
BACKGROUND: Termination of pregnancy (TOP) is not an uncommon procedure. Availability varies greatly between jurisdictions; however, additional institutional processes beyond legislation can also impact care and service delivery. This study serves to examine the role institutional processes can play in the delivery of TOP services, in a jurisdiction where TOP is lawful at all gestations (Victoria, Australia). As per the Abortion Law Reform Act 2008, TOPs post-24 weeks require the approval of two medical practitioners. However, in Victoria, hospitals that offer post-24 week TOPs generally require these cases to additionally go before a termination
review committee for assessment prior to the service being provided. These committees are not stipulated in legislation. Information about these committees and how they operate is scarce and there is minimal information available to the public.
METHODS: To trace the history, function, and decision-making processes of these committees, we conducted a qualitative interview study. We interviewed 27 healthcare professionals involved with these committees. We used purposive sampling to gain perspectives from a range of professions across 10 hospitals. Interviews were transcribed verbatim, identifying details removed and inductive thematic analysis was performed.
RESULTS: Here, we report the three main functions of the committees as described by participants. The functions were to protect: (1) outward appearances; (2) inward functionality; and/or, (3) service users. Function (1) could mean protecting the hospital\'s reputation, with the \"Herald Sun test\"-whether the TOP would be acceptable to readers of the Herald Sun, a tabloid newspaper-used as a heuristic. Function (2) related to logistics within the hospital and protecting the psychological wellbeing and personal reputation of healthcare professionals. The final function (3) related to ensuring patients received a high standard of care.
CONCLUSIONS: The primary functions of these committees appear to be about protecting hospitals and clinicians within a context where these procedures are controversial and stigmatized. The results of this study provide further clarity on the processes involved in the provision of TOPs at later gestations from the perspectives of the healthcare professionals involved. Institutional processes beyond those required by legislation are put in place by hospitals. These findings highlight the additional challenges faced by patients and their providers when seeking TOP at later gestations.
Abortion can be difficult to access. In Victoria, Australia, under the law, abortion is allowed at any time during a pregnancy—although after you have been pregnant for more than 24 weeks, the approval of two doctors is required. However, hospitals in Victoria that offer late abortions require more than the approval of two doctors. Hospitals have put in place committees that
review each case and make a decision about whether the hospital will provide the abortion. There is not a lot of information about these committees—we do not know exactly why they exist, what they are for, or how they work. To find out, we interviewed doctors and other healthcare professionals (like midwives) who were involved in these committees. In this paper, we report the reasons these people gave for why the committees exist and what they are for. There were three main reasons. The first purpose of the committee is so the hospital does not get criticised in newspapers or by other people outside the hospital for performing these late abortions. The second reason is to help and protect those inside the hospital. For example, having a committee means that the doctors do not have to make the decisions themselves. People also said that the committees think about how the staff are feeling. The third reason is so that the hospitals provide the best care they can, and that they can continue to provide late abortions in the future. With this study, we found out some more important information about these committees that we did not have before. What we found shows that it is not just the law that matters—other things can also affect whether you can get an abortion.