Quantifying the Risks and Benefits of Continuing Labor Induction: Data for Shared Decision-Making

2020 ◽  
Author(s):  
Elizabeth Nicole Teal ◽  
Adam K. Lewkowitz ◽  
Sarah L. P. Koser ◽  
Carol B. N. Tran ◽  
Stephanie L. Gaw
Keyword(s):  
Decision Making ◽  
Cesarean Delivery ◽  
Shared Decision Making ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Labor Induction ◽  
Shared Decision ◽  
Risks And Benefits

Abstract Objective To quantify the relative maternal and fetal risks and benefits of continuing labor induction. Study Design This retrospective cohort study included nulliparous women with nonanomalous, singleton, vertex, term pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. The primary outcome was mode of delivery. Secondary outcomes included hemorrhage, transfusion, infection, and composite neonatal morbidity. The data were analyzed using chi-square and Fisher's exact tests. Multivariable regression was used to control for potential confounders. Results A total of 955 patients met the inclusion criteria. The median induction duration was 32.3 hours (interquartile range: 20.4–41 hours) and the vaginal delivery rate was 70.5% (n = 673). The chance of vaginal delivery at 12, 24, 36, 48, 60, and ≥60 hours was 76, 83, 77, 74, 72, and 48%, respectively. After controlling for confounders, there was a 20% decrease in chance of vaginal delivery with induction ≥ 24 hours compared with induction < 24 hours. The adjusted relative risks of hemorrhage, transfusion, and infection with induction ≥ 24 hours compared with induction < 24 hours were 1.9, 2.2, and 2.7, respectively (95% confidence interval [CI] of 1.4–2.5, 1.1–3.9, and 1.8–4.0, respectively). The relative risk for these outcomes remained stable or decreased at each subsequent time point. The increasing risks of hemorrhage and infection were primarily among patients who underwent cesarean delivery. There was no association between induction duration and neonatal morbidity. Conclusion In this cohort, the chance of vaginal delivery remained nearly 50% even when induction extended beyond 60 hours. Risks of hemorrhage and maternal infection rose modestly over time, but primarily in patients who underwent cesarean delivery. There was no difference in the risk of transfusion beyond 24 hours and no association between induction duration and neonatal morbidity. These findings may be useful when engaging patients in shared decision-making during labor induction.

Shared Decision Making

2021 ◽  
Author(s):  
Apurupa Ballamudi ◽  
John Chi
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Information ◽  
Decision Aids ◽  
Treatment Options ◽  
Shared Decision ◽  
Patient Centered ◽  
Risks And Benefits ◽  
Benefit Patient ◽  
Risk And Benefit

Shared decision-making (SDM) is a process in which patients and providers work together to make medical decisions with a patient-centric focus, considering available evidence, treatment options, the patient’s values and goals, and risks and benefits. It is important for all providers to understand how to effectively use SDM in their interactions with patients to improve patients’ experiences throughout their healthcare journey. There are strategies to improve communication between patients and their providers, particularly when communicating quantitative data, risks and benefits, and treatment options. Decision aids (DAs) can help patients understand complex medical information and make an informed decision. This review contains 9 figures, 4 tables and 45 references Key words: Shared decision-making, decision-making, communication, risk and benefit, patient-centered, health literacy, quality of life, decision aids, option grid, pictographs.

817: Shared decision-making for opioid prescribing after cesarean delivery

2017 ◽  
Vol 216 (1) ◽  
pp. S469 ◽  
Author(s):  
Malavika Prabhu ◽  
Emily McQuaid-Hanson ◽  
Stephanie Hopp ◽  
Anjali Kaimal ◽  
Lisa Leffert ◽  
...  
Keyword(s):  
Decision Making ◽  
Cesarean Delivery ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Opioid Prescribing

scholarly journals A Shared Decision-Making Intervention to Guide Opioid Prescribing After Cesarean Delivery

2017 ◽  
Vol 130 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Malavika Prabhu ◽  
Emily McQuaid-Hanson ◽  
Stephanie Hopp ◽  
Sara M. Burns ◽  
Lisa R. Leffert ◽  
...  
Keyword(s):  
Decision Making ◽  
Cesarean Delivery ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Opioid Prescribing

Engaging older people in decisions about their healthcare: the case for shared decision making

2012 ◽  
Vol 22 (2) ◽  
pp. 99-107 ◽  
Author(s):  
Joanne Lally ◽  
Ellen Tullo
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Practice ◽  
Healthcare Professional ◽  
Older People ◽  
Shared Decision Making ◽  
Clinical Condition ◽  
Decision Making Process ◽  
Shared Decision ◽  
Risks And Benefits

SummaryShared decision making in clinical practice involves both the healthcare professional, an expert in the clinical condition and the patient who is an expert in what is important to them. A consultation involving shared decision making enables an examination of the options available, consideration of the risks and benefits whilst incorporating the values of the patient into the decision making process. A decision is aimed at, which is both clinically appropriate and is congruent with the patient's values.Older people have been shown to value involvement, to varying degrees, in decisions about their care and treatment. The case of atrial fibrillation shows the opportunities for, and benefits of, sharing with older people decision making about their healthcare.

scholarly journals Assessment of Physicians' Perspective of Shared Decision Making in a Tertiary Care Hospital in Riyadh, Saudi Arabia

2020 ◽  
Vol 3 (4) ◽  
pp. 119-124
Author(s):  
Hind Almudaimegh ◽  
Sarah Alkanhal ◽  
Futun Alanazi ◽  
Norah Alquraishi
Keyword(s):  
Decision Making ◽  
Saudi Arabia ◽  
Shared Decision Making ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Hard Copy ◽  
Care Hospital ◽  
Shared Decision ◽  
Cross Sectional

ABSTRACT Introduction Shared decision making is an essential component of a patient-centered healthcare system. Several studies have evaluated patients' perception of shared decision making; however, studies reporting physicians' perception of the shared decision-making process are lacking. The objective of this study was to assess physicians' perspectives on shared decision making with their patients in a tertiary care hospital in Riyadh, Saudi Arabia. Methods This is a cross-sectional study, in which we adopted the nine-item physician version of the shared decision-making questionnaire (SDM-Q-Doc) to assess physicians' perception of shared decision making. The questionnaire was distributed online and in hard copy form randomly to our institution's physicians. Results We collected a total of 125 responses from various specialties. Means and percentage of agreement were tested, with the highest percentage of agreement ranging from 88% to 96.8%. There were significant differences between the groups regarding age and medical degree. There were no significant differences noted for sex or department. Conclusion Our findings suggest that most physicians at our institution have a positive attitude toward the process of sharing medical decisions with their patients.

scholarly journals Feasibility of implementing systematic social needs assessment for children with medical complexity

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
David Y. Ming ◽  
Kelley A. Jones ◽  
Elizabeth Sainz ◽  
Heidie Tkach ◽  
Amy Stewart ◽  
...  
Keyword(s):  
Decision Making ◽  
Needs Assessment ◽  
Shared Decision Making ◽  
Tertiary Care ◽  
Social Needs ◽  
Complex Care ◽  
Shared Decision ◽  
Children With Medical Complexity ◽  
Implementation Outcomes ◽  
Medical Complexity

Abstract Background Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs. Methods We implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring. We utilized a multifaceted implementation package consisting of discrete implementation strategies within each phase. In phase 1, we adapted questions from evidence-informed screening tools into a 21-item SSNAC questionnaire, and we used published frameworks to inform implementation readiness and process. In phases 2–3, clinical staff deployed the SSNAC questionnaire to parents of CMC in-person or by phone as part of usual care and adapted to local clinical workflows. Staff used shared decision-making with parents and addressed identified needs by providing information about available resources, offering direct assistance, and making referrals to community agencies. Implementation outcomes included fidelity, feasibility, acceptability, and appropriateness. Results Observations from clinical staff characterized fidelity to use of the SSNAC questionnaire, assessment template, and shared decision-making for follow-up on unmet social needs. Levels of agreement (5-point Likert scale; 1 = completely disagree; 5 = completely agree) rated by staff for key implementation outcomes were moderate to high for acceptability (mean = 4.7; range = 3–5), feasibility (mean = 4.2; range = 3–5), and appropriateness (mean = 4.6; range = 4-5). 49 SSNAC questionnaires were completed with a 91% response rate. Among participating parents, 37 (76%) reported ≥ 1 social need, including food/nutrition benefits (41%), housing (18%), and caregiver needs (29%). Staff responses included information provision (41%), direct assistance (30%), and agency referral (30%). Conclusions It was feasible for tertiary care center-based pediatric complex care programs to implement a standardized social needs assessment for CMC to identify and address parent-reported unmet social needs.

scholarly journals Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

2020 ◽  
Vol 40 (3) ◽  
pp. 279-288
Author(s):  
Eleonore V. Grant ◽  
Jenny Summapund ◽  
Daniel D. Matlock ◽  
Victoria Vaughan Dickson ◽  
Sohah Iqbal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Comparative Method ◽  
Patient Specific ◽  
Shared Decision ◽  
Risks And Benefits

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients’ and cardiologists’ perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients’ and cardiologists’ perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients’ age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as “the only choice,” whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

Cesarean delivery among women with prolonged labor induction

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Louise L. Highley ◽  
Rebecca A. Previs ◽  
Sarah K. Dotters-Katz ◽  
Leo R. Brancazio ◽  
Chad A. Grotegut
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Labor Induction ◽  
University Hospital ◽  
Delivery Rate ◽  
Multivariate Logistic Regression Model ◽  
Nulliparous Women ◽  
Prolonged Labor ◽  
Cesarean Delivery Rate

AbstractObjective:The objective of this study was to determine characteristics associated with cesarean delivery among women with labor induction lasting over 24 h.Study design:Women with live singleton pregnancies without prior cesarean delivery undergoing a labor induction lasting >24 h between September 2006 and March 2009 at Duke University Hospital were identified. Collected variables were compared between subjects by mode of delivery. A multivariate logistic regression model for the outcome cesarean delivery was constructed separately for nulliparous and parous women.Results:There were 303 women who met inclusion criteria. The overall cesarean delivery rate was 57% (n=172) and remained constant with time (P=0.15, test-for-trend). Nulliparous women having a cesarean delivery were more likely to be obese [adjusted OR (aOR) 2.00; 95% CI 1.05, 3.80] and have a larger fetus [aOR 1.11 (aOR for every 100 g increase in birthweight), 95% CI 1.03, 1.20] compared to those having a vaginal delivery.Conclusion:Increasing BMI and birthweight were independent predictors of cesarean delivery among nulliparous women with prolonged labor induction. Despite this, after 24 h of labor induction, the overall mean cesarean delivery rate remained constant at 57%, and did not change with time. Among women having a vaginal delivery following a prolonged labor induction, we saw high rates of shoulder dystocia, operative vaginal delivery and severe perineal laceration.

Sign in / Sign up

Export Citation Format

Share Document