Communicating to promote informed decisions in the context of early pregnancy loss

Objective: To evaluate residents' ability to engage standardized patients in informed decision making during a pregnancy loss scenario. Methods: Forty patient encounters between interns and standardized patients were coded to assess informed decision-making practices, exploration of unexpressed concerns, and support provision. Results: Interns engaged in minimum informed decision making but did not address all of the communicative elements necessary for informed decisions, and most elements were only partially addressed. Patients in this study did not receive information about all management options, their concerns were not addressed, and there was limited support communicated for their decision. Conclusion: This study offers an initial assessment of a communicative approach to evaluate and improve decision making during early pregnancy loss. A comprehensive approach to making informed decisions must include discussion of all management options, exploration of patient preferences and concerns, and support for the patient's decision. Practice implications: Physicians could benefit from communication skills training to communicate more effectively with patients to help them make more informed decisions. (C) 2017 Elsevier B.V. All rights reserved.