Management of congenital female genital tract anomalies related to primary amenorrhea and/or cyclic abdominal pain: A retrospective cohort study.

Autonomy — the ability to form intentions based upon one’s authentic wants, desires, preferences, and goals and to be able to live in such a way that typically those intentions are not frustrated when put into action — is essential to many health protective or otherwise beneficial behaviors in patients(Brody, ). Autonomy matters in physical rehabilitation no less than it matters for pediatric family medicine or palliative care: it is hard to find examples of effective clinical care where autonomy is not important (Georgeff et al., ; O’Neill, ; Schmidt et al., ). Clinicians interact with the autonomy of their patients by acting to support it. This simple idea is the essential core of patient-centered care (Ells et al., ; Frank, ; Lee & Lin, ), but it is also the mechanism by which the ethical ideal of autonomy is translated into practice. The quality and level of autonomy support that clinicians provide should therefore be perceptible to most patients(Brown et al., ), suggesting that it should be possible to track patient autonomy through self-reported instruments which measure perceived autonomy. Determining whether it is possible to track patient autonomy matters because, in clinical practice, autonomy support overlaps substantially with shared decision-making (Deherder et al., ; Kassahun & Zewdie, ; Olwanda et al., ; Vedam et al., ). Shared decision-making occurs when clinicians provide information about medically reasonable options, elicit patient preferences and values, and support patients in deliberating about choices, and it is a well-studied area in clinical research (Arnold et al., ; Edwards & Elwyn, ; Epstein, ). Shared-decision making is especially relevant in pregnancy and postpartum care, where patients often face preference-sensitive decisions and where respectful communication may affect perceived trust, dignity, and agency. In contrast to paternalistic models of care (Sandman & Munthe, , ), shared decision-making provides a concrete clinical mechanism through which autonomy support can be enacted.