Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers.

Gates Open Res

Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, 02903, USA.

Published: October 2024

AI Article Synopsis

  • Male sterilization (vasectomy) is highly effective, with only 2% of women globally relying on it as a contraceptive method in 2019, highlighting a gap in its utilization despite clear benefits.
  • The study involved interviews with 15 vasectomy providers to understand their decision-making processes regarding patient candidacy, focusing on their training, experiences, and the complexities they encounter.
  • Findings revealed that providers must balance patient autonomy with non-maleficence (avoiding harm) in their evaluations, often prioritizing safety even when best practices suggest prioritizing patient choice, particularly in complex cases.

Article Abstract

Background: Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. 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 globally in 2019. Health care providers can be both a facilitator and a barrier in men's health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases.

Methods: Fifteen vasectomy providers belonging to the global Vasectomy Network Google Group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20.

Results: Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy.

Conclusions: Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10861492PMC
http://dx.doi.org/10.12688/gatesopenres.15036.1DOI Listing

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