My Next Birth: Development of a shared decision-making intervention to support informed choice for mode of birth after a previous cesarean

Women are more likely to live longer with chronic illness and have a longterm relationship with their health care provider; this requires a situation in which patients and providers have a role in managing illness. In this chapter, the authors provide a conceptual overview of decision making along with key issues: historical concepts related to patients and providers, consumerism, informed choice/consent, patient rights, shared decision making, patient involvement, as well as an overview of models of patient/provider partnerships. This review builds on the work of O’Connor et al. (1999), which resulted in a Cochrane review of decision aids and focuses the examination of patient decision aids that support women’ decisions regarding health treatment or screening. The authors conclude with a look to the future and recommendations for research in the area of shared decision making and health care decision aids.

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Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03615-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fatemeh Hadizadeh-Talasaz ◽

Faezeh Ghoreyshi ◽

Fatemeh Mohammadzadeh ◽

Roghaieh Rahmani

Keyword(s):

Decision Making ◽

Cesarean Section ◽

Pregnant Women ◽

Shared Decision Making ◽

Mode Of Delivery ◽

Decisional Conflict ◽

Control Group ◽

Shared Decision ◽

Previous Cesarean Section ◽

Previous Cesarean

Abstract Background The promotion of vaginal birth after cesarean section (VBAC) is the best method for the reduction of repeated cesarean sections. Nonetheless, the decisional conflict which often results from inadequate patient involvement in decision making, may lead to delayed decision making and regret about the choices that were made. The present study aimed to determine the effect of shared decision making on the mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section. Methods This randomized clinical trial was conducted on 78 pregnant women with a previous cesarean section referring to community health centers in Torbat-e Jam, Iran, in 2019. They were randomly assigned to two groups of intervention and control. During weeks 24-30 of pregnancy, the Decisional Conflict Scale (DCS) was completed by pregnant mothers. Apart from the routine care, the experimental group received a counseling session which was held based on the three-talk model of shared decision making. This session was moderated by a midwife; moreover, a complementary counseling session was administered by a gynecologist. During weeks 35–37 of pregnancy, DCS was completed, and the Decision Regret Scale (DRS) was filled out for both groups at the 8th weeks postpartum and they were asked about the mode of delivery. Data were analyzed in SPSS software (version 19) using the Mann-Whitney, Chi-squared and Fisher’s exact tests. p-value less than 0.05 was considered statistically significant. Results After the intervention, the decisional conflict score was significantly lower in the shared decision making (SDM) group, compared to that in the control group (14.90 ± 9.65 vs. 25.41 ± 13.38; P < 0.001). Moreover, in the SDM group, the rate of vaginal birth was significantly higher than that in the control group (P < 0.001). Two month after the delivery, the mean score of decision regret was lower in the SDM group, in comparison to that in the control group (15.67 ± 23.37 vs. 27. 30± 26.75; P = 0.007). Conclusions Based on the results of the study, shared counseling can be effective in the reduction of decisional conflict and regret, as well as rate enhancement of VBAC. Therefore, it can be concluded that this counseling method can be used in prenatal care to reduce the rate of repeated cesarean section. Trial registration IRCT20190506043499N1; Name of the registry: Iranian Registry of Clinical Trials; Registered 10. August 2019. URL of registry: https://en.irct.ir/trial/39538. Date of enrolment of the first participant to the trial: August 2019.

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Patient and Provider Perceptions of Decision Making About Use of Epidural Analgesia During Childbirth: A Thematic Analysis

The Journal of Perinatal Education ◽

10.1891/1058-1243.23.3.142 ◽

2014 ◽

Vol 23 (3) ◽

pp. 142-150 ◽

Cited By ~ 4

Author(s):

Holly Bianca Goldberg ◽

Allison Shorten

Keyword(s):

Decision Making ◽

Epidural Analgesia ◽

Shared Decision Making ◽

Thematic Analysis ◽

Informed Choice ◽

Shared Decision ◽

Provider Perceptions ◽

Survey Responses

This study examines the nature of differences in perceptions of decision making between patients and providers about use of epidural analgesia during labor. Thematic analysis was used to identify patterns in written survey responses from 14 patients, 13 labor nurses, and 7 obstetrician–gynecologists. Results revealed patients attempted to place themselves in an informed role in decision making and sought respect for their decisions. Some providers demonstrated paternalism and a tendency to steer patients in the direction of their own preferences. Nurses observed various pressures on decision making, reinforcing the importance of patients being supported to make an informed choice. Differences in perceptions suggest need for improvement in communication and shared decision-making practices related to epidural analgesia use in labor.

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Medical informed choice: understanding the element of time to meet the standard of care for valid informed consent

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137278 ◽

2020 ◽

Vol 96 (1141) ◽

pp. 708-710

Author(s):

Zachary R Paterick ◽

Timothy Edward Paterick ◽

Barb Block Paterick

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Surgical Outcomes ◽

Healthcare Providers ◽

Informed Choice ◽

Standard Of Care ◽

Fiduciary Duty ◽

Shared Decision ◽

Physician Patient Relationship ◽

Legal Principles

Medical informed choice is essential for a physician meeting their fiduciary duty when proposing medical and surgical actions, and necessary for a patient to consent or cull the outlined therapeutic approaches. Informed choice, as part of a shared decision-making model, allows widespread give-and-take of ideas between the patient and physician. This sharing of ideas results in a partnership for decision-making and a responsibility for medical and surgical outcomes.Informed choice is indispensible to the patient education process that meets the desired outcome of any covenant—an offer of and acceptance of the proposed treatment. The covenant anchors a true patient–physician partnership with parity and equality in decision-making and medical/surgical outcomes.Medical informed choice flows from ethical and legal principles necessary to meet the acknowledged standard of care. This is codified by statute and fortified in general common law. This espouses a fiduciary relationship where the patient and physician understand and accede to the degree of autonomy the patient requests.The growth of an equal patient–physician relationship requires time. There is no alternative to the time variable when developing a physician–patient relationship. Despite physicians being under pressures to perform more clinical and administrative duties in less time in the corporate model of medicine, time remains the most critical variable when considering informed choice and shared decision-making. Videos, pamphlets and alternate healthcare providers cannot and should not substitute for physician time.

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Counseling Women with a Previous Cesarean Birth: Toward a Shared Decision‐Making Partnership

Journal of Midwifery & Women s Health ◽

10.1111/jmwh.13093 ◽

2020 ◽

Vol 65 (1) ◽

pp. 177-177

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Shared Decision ◽

Cesarean Birth ◽

Previous Cesarean

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A Shared Decision-Making Toolkit for Mode of Birth After Cesarean

The Journal of Perinatal Education ◽

10.1891/1058-1243.29.1.35 ◽

2020 ◽

Vol 29 (1) ◽

pp. 35-49

Author(s):

Somphit Chinkam ◽

Courtney Steer-Massaro ◽

Karla Damus ◽

Brett Shorten ◽

Allison Shorten

Keyword(s):

Decision Making ◽

Pilot Study ◽

Pregnant Women ◽

Shared Decision Making ◽

Decision Aid ◽

Shared Decision ◽

Racially Diverse ◽

Provider Perspectives ◽

Mode Of Birth ◽

Women's Knowledge

This study evaluated a shared decision-making (SDM) Toolkit (decision aid, counseling guide, and provider scripts) designed to prepare and engage racially diverse women in shared decision-making discussions about the mode of birth after cesarean. The pilot study, involving 27 pregnant women and 63 prenatal providers, assessed women's knowledge, preferences, and satisfaction with decision making, as well as provider perspectives on the Toolkit's acceptability. Most women experienced knowledge improvement, felt more in control and that providers listened to their concerns and supported them. Providers reported that the Toolkit helped women understand their options and supported their counseling. The SDM Toolkit could be used to help women and providers improve their SDM regarding mode of birth after cesarean.

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Shared Decision-Making and the Lower Literate Patient

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2004.tb01981.x ◽

2004 ◽

Vol 32 (4) ◽

pp. 759-764 ◽

Cited By ~ 3

Author(s):

David I. Shalowitz ◽

Michael S. Wolf

Keyword(s):

Health Care ◽

Decision Making ◽

Shared Decision Making ◽

Medical Literature ◽

Informed Choice ◽

Shared Decision ◽

Health Care Needs ◽

Care Needs ◽

Ideal Method ◽

The Ideal

In recent years, shared decision-making has become entrenched in the medical literature and the law as the ideal method for involving patients in decisions related to their health care. Shared decision-making represents a compromise between the opposed extremes of paternalistic interactions that limit patients’ control of their health care, and “informed choice” interactions that require physicians to provide technical expertise only, leaving patients to make all treatment decisions on their own. An implicit goal of shared decision-making is to improve medical care by promoting joint participation of patients and physicians in clinical consultations. The model of shared decision-making may, however, inadequately address the health care needs of lower literate patients, a significant portion of the general population.As shared decision-making is widely held as a clinical ideal, we highlight the difficulties that physicians might have in implementing shared decision-making with lower literate patients.

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The Role of Shared Decision-Making in Audiologic Rehabilitation

Perspectives on Aural Rehabilitation and Its Instrumentation ◽

10.1044/arri21.1.15 ◽

2014 ◽

Vol 21 (1) ◽

pp. 15-23 ◽

Cited By ~ 6

Author(s):

Helen Pryce ◽

Amanda Hall

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Behavior Changes ◽

Shared Decision ◽

Patient Centered ◽

Treatment Information ◽

Centered Care ◽

Potential Risks ◽

Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

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