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Evaluating analgesic disparities in Hispanic parturients: A qualitative analysis
Abstract Number: T 32
Abstract Type: Original Research
Introduction: A racial/ethnic disparity in neuraxial labor analgesia use exists. Hispanic patients are less likely than white patients to anticipate and use neuraxial analgesia. The objective of this qualitative study was to evaluate what sources of information are used and which factors most influence analgesic decision-making in Hispanic parturients.
Methods: An expert panel developed a semi-structured interview guide. Using stratified purposeful sampling, three groups of Hispanic parturients were interviewed on post-partum day 1: those who wanted/used neuraxial analgesia, those who initially did not want but ultimately used neuraxial analgesia, and those who did not want/did not use neuraxial analgesia. Interviews were conducted in English or Spanish based on the patient’s language preference. Interviews were conducted until thematic saturation was achieved. Transcripts were transcribed verbatim. Responses were analyzed using content analysis. Two Spanish-speaking obstetric anesthesiologists developed an initial coding scheme, and the coding schemes were compared. A final coding scheme was developed and applied to all transcripts. Inter-rater reliability was 100%. Descriptive statistics were used to characterize counts and percentages.
Results: A total of 18 participants were interviewed: 5 wanted/used neuraxial analgesia, 11 initially did not want but ultimately used neuraxial analgesia, and 2 did not want or use neuraxial analgesia.
The two most commonly used sources of information were obstetric providers (83%) and friends/family (89%); with patients relying more heavily on information from obstetric providers in their decision-making. All patients were seen by an anesthesiologist intrapartum, but trust in the anesthesiologist varied. When asked if trust in their anesthesiologists affected their analgesic decision making, a representative statement was, “I didn’t know my anesthesiologist.”
All participants were asked about the risks of neuraxial analgesia, and over half the patients cited permanent back pain and paralysis as potential complications. These were the predominant reasons cited for not initially intending to use neuraxial analgesia in the group of patients who ultimately decided to use it intrapartum. All of these patients also stated that their change in attitude was caused by pain, and some specifically noted that their concerns had been alleviated through intrapartum discussions with their providers. Eighty-three percent of patients stated that they would like to have information on labor analgesia given to them during their pregnancy.
Conclusions: Despite having spoken to their obstetric providers and anesthesiologists, misconceptions were prevalent among the Hispanic women interviewed. Patients prefer information from providers, and are desirous of this information prior to labor. Tailored, in-person, educational opportunities for Hispanic patients should be created and evaluated.
Funding: F32HS020122; RWJ award 69779