Using Telemedicine to Improve Early Medical Abortion at Home

Study Overview
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Brief Summary
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The investigators plan a trial comparing telephone consultations for women requesting early medical abortion (EMA - under 10 weeks pregnant) to regular face-to-face consultations. In Scotland, 7 out of 10 women having an abortion choose EMA. The clinic visit to discuss EMA is lengthy (2-3 hours). Much time is spent between having tests and waiting to consult a doctor or nurse. Women can struggle with time off work or childcare for lengthy daytime appointments. There is some evidence from other countries that telephone consultations for EMA are a safe and acceptable alternative. In this study, women seeking EMA will be randomised to face-to-face (standard care) or a planned telephone consultation (in advance of the clinic visit). The investigators will determine the success of the EMA in both groups, women' satisfaction with the consultation and possible advantages and disadvantages. If telephone consultations prove to be effective and acceptable then this will change EMA provision throughout Scotland.

Detailed Description
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This study is a randomised controlled trial comparing telephone consultation to face-to-face consultation prior to early medical abortion at home (EMA). The majority of patients seeking abortion care in NHS Lothian will self-refer by telephone to the Lothian Abortion Referral Service (LARS). Routinely, patients are asked the date of their last menstrual period (LMP) by administrative staff. They then collect basic contact information and book an appointment to come to clinic within 5-7 days. For all women who self report an LMP that is less than 10 weeks to the date of the appointment they are offered, the administrative staff at LARS will read a short statement describing the project and ask if the patient is happy to be contacted by a member of the research team to discuss further. If they agree, they will also be directed to the LARS webpage where a copy of the Participant Information Sheet (PIS) will be available. The patient's contact details will be passed to the research nurse or doctor who will then call the patient back. At call back, the researcher will confirm that the patient has read the PIS and answer any questions and give further information as required. If the patient wishes to participate, verbal consent will be obtained using a standard form. The patient (now participant) will then be randomised to either the intervention arm (telephone consultation) or standard of care (face-to-face consultation). For participants in the standard of care arm: They will attend clinic as usual at the appointment already issued by LARS. After the consultation, they will be asked to complete a questionnaire (either self-administered or researcher-administered) about their preparedness for EMA. 14-20 days later a follow-up questionnaire will be completed with the researcher via telephone, internet or post to assess completion of abortion (using the outcome of a low sensitivity urinary pregnancy test, the standard method used at the abortion service), overall acceptability of consultation and EMA process and what method of contraception they have selected. For participants in the intervention arm: They will have a telephone consultation either immediately after they have been randomised or at another point up to the evening before they are due to attend clinic, depending on their preference. The content of the consultation will be identical to that of a face-to-face consultation. They will attend clinic as planned at their allocated appointment time for an ultrasound scan to confirm gestation, to have standard blood tests and infection screen, complete consent paperwork for their abortion care procedure (as per standard care) and receive their medications. Before leaving the department, they will be asked to complete a questionnaire (either self-administered or researcher-administered) about their preparedness for EMA. 14-20 days later a follow-up questionnaire will be completed with the researcher via telephone, internet or post to assess completion of abortion (using the outcome of a low sensitivity urinary pregnancy test, the standard method used at the abortion service), overall acceptability of consultation and EMA process and what method of contraception they have selected.

Official Title
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Using Telemedicine to Improve Early Medical Abortion at Home

Conditions
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Abortion Early, Abortion in First Trimester

Intervention / Treatment
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* Other: Telephone Consultation
* Other: Face-to-Face Consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Self-reported last menstrual period (LMP) less than 10 weeks on day of appointment Self-referral to Lothian Abortion Referral Service (LARS) Aged 16 or over at the time of procedure Preference for EMA Ability to give informed consent Exclusion Criteria: Requires interpreter Patient preference for surgical method of abortion

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomised Controlled Trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Telephone Consultation for women requesting abortion | Other: Telephone Consultation<br>* A telephone consultation comprising clinical history, contraception planning, explanation of medical method of abortion<br>|
| Active Comparator: Control<br>Face-to-face consultation for women requesting abortion | Other: Face-to-Face Consultation<br>* A face-to-face consultation comprising clinical history, contraception planning, explanation of medical method of abortion<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Efficacy of medical abortion | Complete abortion as assessed by self-performed low-sensitivity urinary pregnancy test | 2 weeks after administration of abortion medications (via telephone) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preparedness for medical abortion | A Likert-scale rating of how prepared participant felt for medical abortion | Within 1 week of randomisation (on day of clinic attendance) | 
| Satisfaction with consultation | A Likert-scale rating of how satisfied participant was with consultation for medical abortion | 2 weeks after administration of abortion medications (via telephone) | 
| Contraception | Rate of uptake of contraceptive methods following consultation | Case note review at 2 weeks | 
| Ineligibility for EMA | Proportion of participants who are not eligible for early medical abortion when they attend clinic for confirmatory ultrasound | Within 1 week of randomisation (on day of clinic attendance) | 
| Time taken | Time taken in consultation and in clinic | Within 1 week of randomisation (on day of clinic attendance) | 
| Unscheduled contact | Unscheduled contact with abortion service or hospital within 4 weeks of EMA for concern related to EMA | 4 weeks after administration of abortion medications | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemedicine, Telephone, Remote