Vasectomy provider decision-making rationales: balancing autonomy and non-maleficence Restricted; Files Only
Hoover, Alison (Spring 2021)
Abstract
Background: Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Engaging men in contraception through vasectomy also contributes to driving more equitable gender norms. 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 in 2019. The contributing factors to low global vasectomy uptake are interrelated and span policy, demand, and supply barriers. The evidence is sparse on supply barriers for vasectomies, and particularly absent on how vasectomy providers evaluate patient candidacy.
Objective: The purpose of this study was to describe the decision-making rationales of experienced vasectomy providers that belong to the global Vasectomy Network google group when evaluating patient candidacy in complex vasectomy cases.
Methods: Fifteen vasectomy providers from seven countries participated in hour-long interviews over Zoom using a semi-structured in-depth interview guide. Providers were asked about their training in vasectomy provision, their reasons for getting involved in vasectomy provision, challenging cases they have faced in their career, and the approaches they use to handle challenging cases. Vignettes were used to help further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20 (VERBI GMBH, Berlin).
Results: Provider decision-making relied heavily upon ensuring that patients were well-informed, able to consent, and certain about their decisions. Once those conditions were met, providers filtered patient characteristics through their training, laws and guidelines, sociocultural norms, experience, and mission and values in order to evaluate the cost-benefit breakdown for particular patients. Based on that cost-benefit analysis, providers then determined whether or not they weighed autonomy or non-maleficence more heavily when evaluating patient candidacy for vasectomy provision.
Discussion: Despite clinical best practices promoting the prioritization of patient autonomy over non-maleficence, some providers continue to emphasize non-maleficence over autonomy, particularly in cases they deem to be at high risk of regret. The findings of this study suggest future trainings of vasectomy providers should focus on evidence-based medicine, shared decision-making, and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.
Table of Contents
Chapter 1: Introduction.................................1
Chapter 2: Literature Review..........................3
Contraceptives..............................................3
Vasectomy....................................................4
Global Uptake of Vasectomy...........................5
Policy barriers..............................................6
Demand barriers...........................................8
Supply barriers.............................................9
Chapter 3: Methods......................................12
Study Design...............................................12
Participant Recruitment...............................12
Data Collection...........................................13
Data Analysis..............................................15
Chapter 4: Results.......................................16
Chapter 5: Discussion..................................51
How vasectomy providers make decisions.....51
How providers rationalize their decisions......53
Current clinical best practices......................55
Implications...............................................58
References..................................................59
Appendix A: Copy of IRB approval letter.......63
Appendix B: Codebook................................65
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File download under embargo until 21 May 2025 | 2021-04-26 14:48:29 -0400 | File download under embargo until 21 May 2025 |
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