Abstract
Objective. To inform UK service development to support medical abortion at home, appropriate for person and context. Design. Realist review Setting/participants Peer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion. Interventions. Interventions and new models of abortion care relevant to the UK. Outcome measures. Causal explanations, in the form of context-mechanism-outcome configurations, to test and develop our realist programme theory. Results. We identified 12 401 abstracts, selecting 944 for full text assessment. Our final review included 50 papers. Medical abortion at home is safe, effective and acceptable to most, but clinical pathways and user experience are variable and a minority would not choose this method again. Having a choice of abortion location remains essential, as some people are unable to have a medical abortion at home. Choice of place of abortion (home or clinical setting) was influenced by service factors (appointment number, timing and wait-times), personal responsibilities (caring/work commitments), geography (travel time/distance), relationships (need for secrecy) and desire for awareness/involvement in the process. We found experiences could be improved by offering: an option for self-referral through a telemedicine consultation, realistic information on a range of experiences, opportunities to personalise the process, improved pain relief, and choice of when and how to discuss contraception. Conclusions. Acknowledging the work done by patients when moving medical abortion care from clinic to home is important. Patients may benefit from support to: prepare a space, manage privacy and work/caring obligations, decide when/how to take medications, understand what is normal, assess experience and decide when and how to ask for help. The transition of this complex intervention when delivered outside healthcare environments could be supported by strategies that reduce surprise or anxiety, enabling preparation and a sense of control.
DOI
10.1136/bmjopen-2022-066650
Publication Date
2022-11-01
Publication Title
BMJ Open
Volume
12
Issue
11
ISSN
2044-6055
Embargo Period
2023-10-13
Organisational Unit
No Org Unit Found
First Page
e066650
Last Page
e066650
Recommended Citation
Baraitser, P., Free, C., Norman, W., Lewandowska, M., Meiksin, R., Palmer, M., Scott, R., French, R., Wellings, K., Ivory, A., & Wong, G. (2022) 'Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review', BMJ Open, 12(11), pp. e066650-e066650. Available at: https://doi.org/10.1136/bmjopen-2022-066650
