'Self-Screening Tool for No-Test Medication Abortion Conservative Compared to Docs'

 A self-screening tool assessing eligibility for no-test medication abortion was conservative in its recommendations compared to physicians, and the experience was acceptable to most patients, a prospective cohort study found.

The self-screening tool recommended ultrasound 73% of the time compared to physicians who only recommended it in 57% of cases, reported Mary Tschann, PhD, MPH, of the University of Hawaii in Honolulu, in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meetingopens in a new tab or window.

"The takeaway is that this is a highly acceptable but conservative mechanism," Tschann said, adding that "the algorithm is very simple and binary" and that "real-time provider assessment allows for more nuance."

Patients were recruited immediately before their scheduled medication abortion visit and completed an online self-screening with educational materials before meeting with a provider. An algorithm then determined if the patient qualified for a no-test medication abortion -- one where eligibility is determined based on patient history without an ultrasound or a pelvic exam -- or if they would need in-person care. No-test medication abortion protocol screens outpatients who have contraindications to medication abortion or risk factors for ectopic pregnancy.

The patients then proceeded with their scheduled in-person or telemedicine medication abortion appointment. Physicians were blind to screening tool results when they determined if an ultrasound was required or not.

In total, 35 patients self-screened to no ultrasound and the physician concurred for 29 of them. The disconnect on the remaining six was due to patients giving conflicting information to the self-screening tool and to the physician, like being certain about the date of their last menstrual period or if they experienced cramping.

In situations when an ultrasound was reasonable but not required, the doctor may have conducted one at the request of the patient, Tschann noted.

Patients then rated the acceptability of the screening and education and completed a quiz about the medication abortion process. The vast majority (90%) answered all questions about the process correctly and 72% thought the video education was sufficient and didn't feel the need to further consult with a physician.

Both the 2020 COVID lockdowns and the 2022 Dobbs decision that overturned the federal right to abortion have contributed to lessened face-to-face visit requirements for abortion services. Past research has proven that mail-order medication abortionopens in a new tab or window is both effective and acceptable to patients, as is telehealthopens in a new tab or window.

"We know these models of care are safe, effective, and increasingly common," said Tschann. "Medication abortion is moving out of the clinician's office and into the patient's home and our question was, what tools do we have to offer our patients?"

Kelsey Loeliger, MD, PhD, a complex family planning fellow at the University of California San Diego, who was not involved in this study, said that it seemed patients found the educational materials helpful -- especially when it came to when to seek help; 93% of respondents correctly answered that they should seek emergency help or consult a physician if they were soaking more than two pads an hour after a medication abortion.

Loeliger also noted that the research was well conducted and that although there wasn't "100% concordance between the physician assessment and patient self-assessment outcomes, if anything, the patient self-assessment is generally more conservative in that it leans toward recommending ultrasound, so the probability of missing something when using a self-screener like this is quite low."

She also noted that this kind of self-screening and educational resources can empower patients, including "those who are living in restrictive or hostile reproductive health environments where they may be afraid to seek medical care."

This prospective study took place in Honolulu from January 2023 to July 2024. In total, 128 patients were enrolled with a mean age of 26. Most (70%) had nev

Disclosures

Tschann had no disclosures.

Co-authors reported relationships with Organon, Merck, NIH, and HRSA.

Loeliger had no disclosures.

Primary Source

American College of Obstetricians and Gynecologists

Source Reference: opens in a new tab or windowTschann M "Self-screening and patient-education tool for medication abortion: accuracy and acceptability" ACOG 2025.

https://www.medpagetoday.com/meetingcoverage/acog/115685