{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:26:36Z","timestamp":1786983996118,"version":"build-2736575974"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi260797-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Hospital-based labor and delivery (L&amp;amp;amp;D) units have clinical expertise to provide second-trimester induction abortion and can help ensure patient access to abortion as legal and systematic barriers shift the US care landscape. However, hospitals may be reluctant to expand abortion services because of concerns regarding staff acceptance, stigma, and workforce readiness; understanding perinatal personnel\u2019s experiences with a structured values clarification and attitude transformation (VCAT) workshop can inform efforts to prepare L&amp;amp;amp;D teams for abortion services implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260797-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore perinatal personnel\u2019s experiences with a VCAT workshop on abortion perspectives and professional responsibilities before implementation of second-trimester induction abortion services in a L&amp;amp;amp;D unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260797-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>In this qualitative study, VCAT workshops about abortion were provided to 174 perinatal health care personnel at an urban community-based hospital in California from July 1 to October 31, 2023, before implementation of second-trimester induction abortion services. After the workshops, 25 participants, including nurses, physicians, and midwives, were interviewed between November and December 2023. Data analysis was performed from July 2024 to January 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260797-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>A single, 1-hour VCAT workshop that used a virtual adaptation of the Four Corners exercise, which is a previously published VCAT method that prompts participants to reflect on and represent a spectrum of abortion viewpoints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260797-8\">\n                    <jats:title>Main Outcome and Measures<\/jats:title>\n                    <jats:p>Perceptions of perinatal personnel regarding abortion care and their experience with a VCAT workshop about abortion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260797-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten workshops were conducted with 174 perinatal personnel (137 nurses and staff, 19 certified nurse midwives, and 18 obstetrician-gynecologists), with a median of 17 attendees (range, 4-36). Four major themes in perinatal personnel\u2019s experiences with the VCAT workshop were identified: (1) personal and professional contexts, such as personal abortion experiences, workplace stress, and influence of increasing national abortion restrictions on how participants experienced the workshop; (2) promotion of personal reflection and perspective-taking, where participants described how representing others\u2019 views deepened their understanding of their own beliefs, challenged assumptions about colleagues, and fostered empathy; (3) reflection on professional responsibilities and the role of L&amp;amp;amp;D in abortion care, with some viewing abortion care as outside the scope of L&amp;amp;amp;D services and others seeing it as another way to provide inclusive, compassionate care to pregnant people; and (4) reinforcement of respect for autonomy as a core shared value, even among those with differing personal beliefs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi260797-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This qualitative study of perinatal care personnel preparing to implement induction abortion services in the L&amp;amp;amp;D unit found that VCAT workshops provided structured opportunities for perinatal personnel to reflect on the complex personal and professional dimensions of abortion care. These findings suggest VCAT workshops may support multidisciplinary perinatal teams in implementation of second-trimester induction abortion services with empathy, professionalism, and cohesion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.29306","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:30:33Z","timestamp":1786980633000},"page":"e2629306","source":"Crossref","is-referenced-by-count":0,"title":["Experiences of Perinatal Personnel With Values Clarification Workshops About Abortion"],"prefix":"10.1001","volume":"9","author":[{"given":"Laura","family":"Jacques","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Wisconsin\u2013Madison, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Cowley","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health, University of Wisconsin\u2013Madison, Madison"},{"name":"Now with Department of Family Medicine, Full Circle Health, Boise, Idaho"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie","family":"Lapp","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health, University of Wisconsin\u2013Madison, Madison"},{"name":"Now with Department of Obstetrics and Gynecology, Prisma Health\/University of South Carolina School of Medicine, Greenville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacquelyn","family":"Askins","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Wisconsin\u2013Madison, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Altshuler","sequence":"additional","affiliation":[{"name":"Alameda Health System, Oakland, California"},{"name":"Now with Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"issue":"3","key":"zoi260797r1","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.ijgo.2011.10.016","article-title":"Women\u2019s decision making regarding choice of second trimester termination method for pregnancy complications.","volume":"116","author":"Kerns","year":"2012","journal-title":"Int J Gynaecol Obstet"},{"issue":"10","key":"zoi260797r2","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1016\/j.pec.2018.06.012","article-title":"Decision satisfaction among women choosing a method of pregnancy termination in the setting of fetal anomalies and other pregnancy complications: a qualitative study.","volume":"101","author":"Kerns","year":"2018","journal-title":"Patient Educ Couns"},{"issue":"7","key":"zoi260797r3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006714.pub3","article-title":"Surgical versus medical methods for second-trimester induced abortion.","volume":"7","author":"Atrio","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"zoi260797r4","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1097\/01.AOG.0000431056.79334.cc","volume":"121","author":"American College of Obstetricians and Gynecologists","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"4","key":"zoi260797r5","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.ajog.2023.09.097","article-title":"Society of Family Planning Clinical Recommendation: medication abortion between 14 0\/7 and 27 6\/7 weeks of gestation: jointly developed with the Society for Maternal-Fetal Medicine.","volume":"233","author":"Zwerling","year":"2025","journal-title":"Am J Obstet Gynecol"},{"issue":"7","key":"zoi260797r7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7307a1","article-title":"Abortion surveillance - United States, 2022.","volume":"73","author":"Ramer","year":"2024","journal-title":"MMWR Surveill Summ"},{"issue":"4","key":"zoi260797r8","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1363\/psrh.12215","article-title":"Abortion incidence and service availability in the United States, 2020.","volume":"54","author":"Jones","year":"2022","journal-title":"Perspect Sex Reprod Health"},{"issue":"2","key":"zoi260797r9","doi-asserted-by":"publisher","first-page":"e86","DOI":"10.1097\/AOG.0000000000005804","article-title":"Increasing access to abortion: ACOG Committee Statement No. 16.","volume":"145","author":"Increasing Access to Abortion","year":"2025","journal-title":"Obstet Gynecol"},{"issue":"6","key":"zoi260797r10","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1097\/AOG.0000000000003876","article-title":"Abortion policies in US teaching hospitals: formal and informal parameters beyond the law.","volume":"135","author":"Zeldovich","year":"2020","journal-title":"Obstet Gynecol"},{"key":"zoi260797r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2026.111364","article-title":"Understanding U.S. non-religious hospital inpatient approval mechanisms for induced abortion.","volume":"158","author":"Rankin","year":"2026","journal-title":"Contraception"},{"issue":"6","key":"zoi260797r12","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.contraception.2015.02.007","article-title":"Recruitment and retention strategies for expert nurses in abortion care provision.","volume":"91","author":"McLemore","year":"2015","journal-title":"Contraception"},{"key":"zoi260797r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmhs.2026.100168","article-title":"How US healthcare institutions\u2019 actions, or inactions, shaped physician experiences after Dobbs: a qualitative study.","volume":"6","author":"Jacques","year":"2026","journal-title":"SSM Health Syst"},{"issue":"7","key":"zoi260797r14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0303601","article-title":"Providers\u2019 experiences with abortion care: a scoping review.","volume":"19","author":"Dempsey","year":"2024","journal-title":"PLoS One"},{"issue":"6","key":"zoi260797r15","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.contraception.2018.07.003","article-title":"Relationship of job role and clinic type to perceived stigma and occupational stress among abortion workers.","volume":"98","author":"Janiak","year":"2018","journal-title":"Contraception"},{"key":"zoi260797r16","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2022.103363","article-title":"Experiences of midwives and nurses when implementing abortion policies: a systematic integrative review.","volume":"111","author":"Carvajal","year":"2022","journal-title":"Midwifery"},{"issue":"9","key":"zoi260797r17","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1016\/j.socscimed.2011.08.019","article-title":"Resistance and vulnerability to stigmatization in abortion work.","volume":"73","author":"O\u2019Donnell","year":"2011","journal-title":"Soc Sci Med"},{"key":"zoi260797r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.srhc.2023.100889","article-title":"Midwifery care for late termination of pregnancy: integrative review.","volume":"37","author":"Armour","year":"2023","journal-title":"Sex Reprod Healthc"},{"issue":"1","key":"zoi260797r19","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1186\/s12889-017-4764-z","article-title":"Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis.","volume":"17","author":"Glenton","year":"2017","journal-title":"BMC Public Health"},{"key":"zoi260797r20","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-8080(08)31389-5","article-title":"Clarifying values and transforming attitudes to improve access to second trimester abortion.","author":"Turner","year":"2008","journal-title":"Reprod Health Matters"},{"issue":"1","key":"zoi260797r21","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s12978-018-0480-0","article-title":"Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre-post assessment in 12 countries.","volume":"15","author":"Turner","year":"2018","journal-title":"Reprod Health"},{"issue":"1","key":"zoi260797r23","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2025.2465643","article-title":"Does a values clarification and attitudes transformation (VCAT) workshop influence provider attitudes, knowledge, and service provision related to abortion care? evidence from a mixed-methods longitudinal randomised controlled trial in Ethiopia.","volume":"20","author":"Wollum","year":"2025","journal-title":"Glob Public Health"},{"issue":"9","key":"zoi260797r24","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: a synthesis of recommendations.","volume":"89","author":"O\u2019Brien","year":"2014","journal-title":"Acad Med"},{"issue":"1","key":"zoi260797r26","doi-asserted-by":"publisher","DOI":"10.1080\/10872981.2023.2258004","article-title":"An online alternative: a qualitative study of virtual abortion values clarification workshops.","volume":"28","author":"Williams","year":"2023","journal-title":"Med Educ Online"},{"key":"zoi260797r27","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research.","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"zoi260797r29","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.socscimed.2019.03.034","article-title":"Conscience reconsidered: the moral work of navigating participation in abortion care on labor and delivery.","volume":"232","author":"Czarnecki","year":"2019","journal-title":"Soc Sci Med"},{"issue":"3","key":"zoi260797r30","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.contraception.2021.04.014","article-title":"\u201cIt\u2019s a horrible assignment\u201d: a qualitative study of labor and delivery nurses\u2019 experience caring for patients undergoing labor induction for fetal anomalies or fetal demise.","volume":"104","author":"Zwerling","year":"2021","journal-title":"Contraception"},{"issue":"3","key":"zoi260797r31","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1002\/nur.21655","article-title":"Calculus formation: nurses\u2019 decision-making in abortion-related care.","volume":"38","author":"McLemore","year":"2015","journal-title":"Res Nurs Health"},{"key":"zoi260797r22","volume-title":"Accelerating the Pace of Progress in South Africa: An Evaluation of the Impact of Values Clarification Workshops on Termination of Pregnancy Access in Limpopo Province","author":"Mitchell","year":"2004"},{"key":"zoi260797r28","author":"Rifaqat"},{"key":"zoi260797r6","unstructured":"World Health Organization. Abortion care guideline. 2022. Accessed July 7, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240039483"},{"key":"zoi260797r25","unstructured":"Turner? KL, Chapman Page? K. Abortion attitude transformation: a values clarification toolkit for global audiences. Published online 2008. Accessed December 10, 2025. https:\/\/www.ipas.org\/resource\/abortion-attitude-transformation-a-values-clarification-toolkit-for-global-audiences\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2852894\/jacques_2026_oi_260797_1786551136.8053.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:30:34Z","timestamp":1786980634000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2852894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":31,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.29306","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]}}}