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Women's Choices (women + choice)
Selected AbstractsWomen's choice between sentinel lymph node biopsy and axillary clearanceANZ JOURNAL OF SURGERY, Issue 2 2002Steven Gan Purpose: To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality. Methods: The expected 5-year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided subjects with a scenario and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists. Results: One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room subjects chose SLNB rather than AC. Conclusions: Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC. Abbreviations: AC, axillary clearance; SLNB, sentinel lymph node biopsy. [source] Ascertaining women's choice of title during pregnancy and childbirthAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2002Angela S Denning ABSTRACT Methods A questionnaire was administered to 958 women attending the antenatal clinic at Mercy Hospital for Women, Melbourne, to ascertain their choice of title during pregnancy. Midwifery, nursing and medical staff (376 in total) were also invited to respond to a similar questionnaire. Results The response rate was 73.6% from the survey of all women who were overwhelmingly in favour of being called ,patient' as their first choice (34%), followed by ,other' (20%) and then ,mother' (19%). Virtually all women requesting ,other' wished to be called by their name. Women wishing to be called ,patient' for first choice did not significantly differ from the remainder of the study group in age, gestation, number of previous pregnancies, or number of children. When women from the Family Birth Centre (FBC) were analysed as a separate group, they had a clear preference to be called ,other' (unanimously, by their name) than the general antenatal population (odds ratio (OR) 5.1; 95% confidence interval (CI) 3.1, 8.3; p < 0.0001). The staff survey, with a response rate of 84%, also demonstrated that ,patient' was the most popular first choice for patient title. Medical staff were significantly more likely to choose ,patient' (OR 4.2, 95% CI 2.3, 7.7; p < 0.0001), though the term ,patient' was the preferred choice of all staff. [source] Factors Associated with the Choice of Delivery without Epidural Analgesia in Women at Low Risk in FranceBIRTH, Issue 3 2008Camille Le Ray MD ABSTRACT: Background: Regional anesthesia is used for three-fourths of the deliveries in France. Epidural analgesia during labor is supposed to be available to all women at low risk. The purpose of our study was to examine how the choice of delivery without an epidural varied in this context according to women's characteristics, prenatal care, and type of maternity unit. Methods: The 2003 National Perinatal Survey in France collected data about a representative sample of births. We selected 8,233 women who were at low risk and therefore should have been able to choose whether or not to deliver without epidural analgesia. Women were interviewed in the maternity unit after delivery. The factors associated with women's choice to deliver without epidural analgesia were studied with multivariable analyses. Results: Of the 2,720 women who gave birth without epidural analgesia, 37 percent reported that they had not wanted one; other reasons were labor occurring too quickly (43.9%), medical contraindication (3.3%), and unavailability of an anesthesiologist (2.8%). The reported decision to deliver without epidural analgesia was closely associated with high parity. It was also more frequent among women in an unfavorable social situation (not cohabiting, no or low-qualified job) and among women who gave birth in nonuniversity public hospitals, in small- or medium-sized maternity units, and in maternity units without an anesthesiologist always on site. Conclusions: Unfavorable social situation and organizational factors are associated with the reported choice to give birth without epidural analgesia. This finding suggests that women are not always in a position to make a real choice. It would be useful to improve the understanding of how pregnant women define their preferences and to know how these preferences change during pregnancy and labor. (BIRTH 35:3 September 2008) [source] A decision theory perspective on why women do or do not decide to have cancer screening: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 6 2009Kelly Ackerson Abstract Title.,A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. Aim., This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening. Background., Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women's choices to improve adherence. Data sources., Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria. Methods., Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing. Findings., All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo. Conclusion., Nurses need to address proactively women's perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits. [source] Agricultural Land, Gender and Kinship in Rural China and Vietnam: A Comparison of Two VillagesJOURNAL OF AGRARIAN CHANGE, Issue 2 2009DANIÈLE BÉLANGER This study examines the impact of current land policies in China and Vietnam on women's entitlement to land, women's wellbeing and gender power relations. The ethnographic study of one village in each of the two countries contextualizes women's lives in the kinship and marriage system in which power and gender relations are embedded. Current land policies, when implemented in the existing kinship and marriage system, make women's entitlement to land more vulnerable than men's, limit women's choices and weaken their power position. Variations in kinship rules in the two countries lead to different outcomes. In the Chinese village the dominance of patrilocal marriage and exogamous marriages limits women's access to land, whereas in the Vietnamese village the rigid concentration of inheritance to males puts women in a difficult position. The comparison between communities of rural China and Vietnam reveals the importance of considering gender and kinship when studying the implementation and impact of land policies. [source] A Study of Midlife Women's Reasons for Changing Healthcare ProvidersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2005FACNM, Holly Powell Kennedy CNM Purpose The purpose of this study was to examine the reasons midlife women report for changing healthcare providers and to determine if there were any differences in reasons given for the change based on gender or ethnicity. Data sources This was an analysis of data collected from a healthy community-based sample of midlife women as part of a longitudinal 5-year study of changes in health outcomes during transition to menopause. Women were queried about their experience in changing healthcare providers. Conclusions Over 42% indicated that they had changed health providers because of dissatisfaction with care. The component accounting for the majority of the variance was related to communication issues. There were no significant differences across ethnic groups in decision to change providers or in reasons for their dissatisfaction with care. However, their reports of experiencing racism in the healthcare system were troubling. Implications for practice The ability of the provider to communicate with women may have implications in women's choices in health care later in life. [source] Birth Position, Accoucheur, and Perineal Outcomes: Informing Women About Choices for Vaginal BirthBIRTH, Issue 1 2002Allison Shorten RN Background:,The literature is tentative in establishing links between birth position and perineal outcome. Evidence is inconclusive about risks and benefits of women's options for birth position. The objective of this study was to gain further evidence to inform perinatal caregivers about the effect of birth position on perineal outcome, and to assist birth attendants in providing women with information and opportunities for minimizing perineal trauma. Methods:,Data from 2891 normal vaginal births were analyzed. Descriptive statistics were obtained for variables of interest, and cross-tabulations were generated to explore possible relationships between perineal outcomes, birth positions, and accoucheur type. Logistic regression models were used to examine potential confounding and interaction effects of relevant variables. Results:,Multiple regression analysis revealed a statistically significant association between birth position and perineal outcome. Overall, the lateral position was associated with the highest rate of intact perineum (66.6%) and the most favorable perineal outcome profile. The squatting position was associated with the least favorable perineal outcomes (intact rate 42%), especially for primiparas. A statistically significant association was demonstrated between perineal outcome and accoucheur type. The obstetrician group generated an episiotomy rate of 26 percent, which was more than five times higher than episiotomy rates for all midwife categories. The rate for tear requiring suture of 42.1 percent for the obstetric category was 5 to7 percentage points higher than that for midwives. Intact perineum was achieved for 31.9 percent of women delivered by obstetricians compared with 56 to 61 percent for three midwifery categories. Conclusion:,Findings contribute to growing evidence that birth position may affect perineal outcome. Women's childbirth experiences should reflect decisions made in partnership with midwives and obstetricians who are equipped with knowledge of risks and benefits of birthing options and skills to implement women's choices for birth. Further identification and recognition of the strategies used by midwives to achieve favorable perineal outcomes is warranted. (BIRTH 29:1 March 2002) [source] | ||||||||||