Anticipatory Counseling About Miscarriage Management in Catholic Hospitals: A Qualitative Exploration of Women's Preferences.

CONTEXT: Catholic hospitals represent a large and growing segment of U.S. health care. Because these facilities follow doctrines that restrict reproductive health services, including miscarriage management options when a fetal heartbeat is present, it is critical to understand whether and how women would want to learn about miscarriage treatment restrictions from providers. METHODS: From May 2018 to January 2019, semistructured interviews were conducted with 31 women aged 21-44 who had had exposure to religious-based health care; all were drawn from a nationally representative survey sample. Participants responded to a hypothetical scenario regarding the anticipatory disclosure of miscarriage management policy during routine prenatal care. Responses were inductively coded and thematically analyzed using modified grounded theory to understand women's attitudes and considerations related to receiving anticipatory miscarriage management information. RESULTS: Respondents supported the routine disclosure of miscarriage management policies during prenatal care. Some expressed concern that this might increase patient anxiety during pregnancy, but most felt that the information would serve to prepare and empower patients, and likened the topic to other anticipatory health information provided during prenatal care. Identified themes related to how providers can disclose this information (including the need for a precautionary framing to reduce patient stress), sharing the rationale for institutional policy, and the importance of provider neutrality to ensure patient autonomy. CONCLUSIONS: To respect patient autonomy, health care providers working in Catholic hospitals should routinely discuss institutional miscarriage management policies with patients, and anticipatory counseling should give patients the balanced information they need to decide where to go for care should pregnancy complications arise.

Restrictions on Reproductive Care at Catholic Hospitals: A Qualitative Study of Patient Experiences and Perspectives.

BACKGROUND: Previous studies have shown that many women who would seek care at Catholic hospitals are unaware of the hospital's religious affiliation. Furthermore, women often do not realize that these institutions operate according to religious beliefs that restrict access to certain reproductive services. Our study aimed to gain patient perspectives on experiences seeking reproductive care at religiously affiliated institutions. METHODS: We conducted a qualitative study using in-depth interviews with 33 women who reported experiences seeking reproductive services at Catholic hospitals. Interview questions focused on women's experiences with religious restrictions, their attitudes towards religious healthcare, and whether and how they think women should be informed of these restrictions. Interviews were thematically analyzed using Dedoose software, applying both a priori concepts such as patient autonomy, informed decision making, and transparency, as well as new concepts that emerged from the data or denoted unanticipated distinctions within codes. RESULTS: In this paper, we present three findings. First, women value both patient autonomy and hospital religious freedom. Struggling to reconcile these, many blamed themselves for not anticipating religious restrictions. Second, barriers to information prevent women from researching restrictions ahead of time. Third, women would like more information about these restrictions from both doctors and hospitals. CONCLUSION: Public policy that regulates hospitals should require transparency from hospitals and physicians about religious restrictions on care. Informing the public about religious policies and how they affect reproductive care will allow patients to better anticipate differences and make informed decisions about where to seek care.

Do women know whether their hospital is Catholic? Results from a national survey.

OBJECTIVES: Catholic healthcare limits access to common reproductive care. We assessed what percentage of US women seeking care at Catholic hospitals are aware of their hospital's religious affiliation and identified variables associated with correct identification. STUDY DESIGN: We conducted a national survey of women ages 18-45 (response rate 50%). The survey asked participants what hospital they would go to for reproductive care and what the religious affiliation of that hospital was. We verified responses as correct or incorrect against a known Catholic hospital list. We used bivariate analysis and logistic regressions to evaluate factors associated with correct identification. RESULTS: Sixteen percent of women reported a Catholic hospital as their primary hospital for reproductive care. Among women whose primary hospital was Catholic, 63% [95% confidence interval (CI): 54.5-70.7] correctly identified this, compared to 93% who correctly identified their hospital as non-Catholic (95% CI 91.4 - 95.0). Two thirds of respondents who misidentified their Catholic hospital's affiliation reported that their hospital was secular (66%), and 48% of those women felt sure or very sure of their incorrect response. Factors associated with correctly identifying Catholic hospitals included hospital with a religious-sounding name [adjusted odds ratio (aOR)=2.80; 95% CI: 1.07-7.34], respondent older age (aOR=3.77; 95% CI: 1.35-10.56), metropolitan residence (aOR=3.35; 95% CI: 1.01-11.10) and income over $100,000 (aOR 4.95; 95% CI 1.35 - 18.17). CONCLUSION: Over one third of US women who named a Catholic hospital as their primary hospital for reproductive care are unaware it is Catholic. Women are more likely to correctly identify a hospital as Catholic when that hospital has a religious sounding name. IMPLICATIONS: Patients need accurate information in order to make decisions about where to seek reproductive healthcare. Our results suggest that women are often unaware of their hospital's religious affiliation. Efforts are needed to increase hospital transparency and patient awareness of the implications that arise when healthcare is restricted by religion.