Table 2 Typology of factors influencing obstetricians’ acceptance of TOP after the trimester
Clinical factors | |
|---|---|
Presence of a fetal health problem | |
Combined deviating test result + detectable physical defects | |
Mortality risk | |
Treatability - operability | |
Type of health consequences: mental vs. physical impairment | |
Perceived suffering and quality of life future child | |
Level of certainty of (severe) prognosis | |
Level of severity | |
Presence of a maternal health problem | |
Mortality risk | |
Level of certainty of (severe) prognosis | |
Level of severity | |
Treatability - operability | |
Type of health problem: somatic vs. psychological vs. social health problem | |
Estimated effect of TOP decision on evolution of health problem | |
Estimated level of prematurity and related issues for neonate | |
Combination of maternal and fetal health problems | |
Factors related to background of patient | |
Impact on other children | |
Care capacity and support network | |
Patient or family member has the same condition | |
Possibility to conceive again | |
Socio-economic background | |
Psychosocial vulnerability | |
Mental vulnerability | |
Forced, unwanted, or unplanned conception | |
Factors related to patient’s request for TOP | |
Persistence and determination from patient - pressure on professional | |
Wish of patient ultimately decisive | |
Factors related to the professional | |
- Ethical and professional values and role perception | |
- Distancing from decision - non-directive counselling | |
- Acknowledging interests of the future child | |
- Acknowledging parental and family interests | |
- Valuing consistency | |
- Personally feeling (un)comfortable with performing TOP | |
- Loyalty to patient as treating health professional | |
- Past experiences | |
- In professional life | |
- In personal life | |
Institutional and team factors | |
Ability to refer patient and relinquish authority to decide to other institution | |
Precedents - consensus has emerged in team/department/institution | |
Protocols or agreements from team/department/hospital | |
- Collective decision-making or advice process | |
- Advice from specialist | |
- (Multidisciplinary) team decision | |
- Advice from Ethics Committee | |
Types of specialisms involved in collective decision or advice organ | |
Technical factors | |
Positive experience with medical TOP | |
- Perceived challenges of surgical TOP method or prior feticide (when considered necessary to perform TOP) | |
- Technical challenges for health professional | |
- Surgical TOP or feticide considered morally challenging | |
- Health or emotional challenges for patient | |
Time-related factors | |
- Advanced gestational age | |
- Increased certainty over clinical factors | |
- Identical health condition, identical decision | |
- Preventability of later timing of TOP | |
Viability | |
Legal factors | |
Abortion/feticide (not) clearly permitted by the Abortion Law | |
Risk of medico-legal complaints | |
Flexibility of the Abortion Law | |
Fetus is not a legal person before birth | |
Factors related to the perception and availability of alternatives to TOP | |
Adoption - psychosocial and financial support of patient/parents | |
Birth and palliative comfort care | |
Postnatal active end-of-life intervention |