title: Counseling women with early pregnancy failure: utilizing evidence, preserving preference.
abstract: OBJECTIVE
  To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management.
  
  
  METHODS
  Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice.
  
  
  RESULTS
  Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management.
  
  
  CONCLUSIONS
  Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options.
  
  
  CONCLUSIONS
  Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options.
authors.affiliation: University of California, San Francisco, Department of Family and Community Medicine, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110, USA. wallacer@fcm.ucsf.edu
authors.forename: Robin R
authors.initials: RR
authors.lastname: Wallace
authors.forename: Suzan
authors.initials: S
authors.lastname: Goodman
authors.forename: Lori R
authors.initials: LR
authors.lastname: Freedman
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Harris
mesh_terms: D000022:Abortion, Spontaneous / Q000523:psychology*; D057189:Checklist; D002755:Choice Behavior; D003376:Counseling; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008962:Models, Theoretical; D057240:Patient Preference; D011247:Pregnancy; D011369:Professional-Patient Relations