Patient Engagement and Shared Decision Making in Maternity Care

Introduction: Though engaging patients with atrial fibrillation (AF) in the decision-making process for stroke prevention is encouraged by guidelines, little is known about the extent of, and the factors associated with, patient engagement in this process. Hypothesis: Patient engagement in shared decision-making (SDM) would be modest and that older participants will less likely engage in SDM for stroke prevention. Methods: Data are from the ongoing SAGE (Systematic Assessment of Geriatric Elements)-AF study which enrolled older adults aged 65 years and older with AF from clinics in Massachusetts and Georgia. Participants on an oral anticoagulant (OAC) reported whether they were engaged in the decision to be on an OAC by answering “Yes” to the question: “Did you participate actively in choosing to take an OAC?”. We used multiple logistic regression analysis to examine the sociodemographic, geriatric, psychosocial, and clinical factors associated with patient engagement in SDM for stroke prevention. Results: Participants (N= 807) were on average 75 years old and 48% were female. Approximately, 61% engaged in the decision to be on an OAC. Participants aged 80 years and older (aOR= 0.53; 95 % CI:0.31-0.89) and those cognitively impaired (aOR= 0.69; 95 % CI: 0.48, 0.99) were less likely to engage in SDM than respective comparison groups. Participants who reported being very knowledgeable of their AF associated risk of stroke had higher odds of engaging in SDM than those with less knowledge (aOR= 3.06; 95 % CI:1.59, 5.90). Conclusions: Clinicians should identify older patients and those who are cognitively impaired who are less likely to engage in SDM for stroke prevention, promote patient engagement, and provide support to ensure sustained engagement that would enhance long-term treatment outcomes for patients with AF.

Download Full-text

Shared decision-making and patient engagement program during acute exacerbation of COPD hospitalization: A randomized control trial

Patient Education and Counseling ◽

10.1016/j.pec.2019.12.004 ◽

2020 ◽

Vol 103 (4) ◽

pp. 702-708 ◽

Cited By ~ 2

Author(s):

María Granados-Santiago ◽

Marie Carmen Valenza ◽

Laura López-López ◽

Esther Prados-Román ◽

Janet Rodríguez-Torres ◽

...

Keyword(s):

Decision Making ◽

Acute Exacerbation ◽

Shared Decision Making ◽

Patient Engagement ◽

Randomized Control Trial ◽

Shared Decision ◽

Acute Exacerbation Of Copd ◽

Randomized Control ◽

Exacerbation Of Copd

Download Full-text

Women’s Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients’ Health Literacy Skills and Needs for Support

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031130 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1130

Author(s):

Laxsini Murugesu ◽

Olga C. Damman ◽

Marloes E. Derksen ◽

Danielle R. M. Timmermans ◽

Ank de Jonge ◽

...

Keyword(s):

Decision Making ◽

Health Literacy ◽

Shared Decision Making ◽

Maternity Care ◽

General Information ◽

Literacy Skills ◽

Reliable Information ◽

Functional Health ◽

Shared Decision ◽

Participation In Decision Making

Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women’s HL skills and needs for support regarding shared decision-making in maternity care. In-depth interviews were held among women in Dutch maternity care who scored low (n = 10) and high (n = 13) on basic health literacy screening test(s). HL skills and perceived needs for support were identified through thematic analysis. Women appeared to be highly engaged in the decision-making process. They mentioned searching and selecting general information about pregnancy and labor, constructing their preferences based on their own pre-existing knowledge and experiences and by discussions with partners and significant others. However, women with low basic skills and primigravida perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information and preparing for consultations. Women also emphasized dealing with uncertainties, changing circumstances of pregnancy and labor, and emotions. Maternity care professionals could further support clients by guiding them towards reliable information. To facilitate participation in decision-making, preparing women for consultations (e.g., agenda setting) and supporting them in a timely manner to understand benefit/harm information seem important.

Download Full-text

Women’s traumatic childbirth experiences: Reflections and implications for practice

10.33118/oaj.preg.2019.01.001 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Fontein-Kuipers Yvonne

Keyword(s):

Decision Making ◽

Informed Consent ◽

Shared Decision Making ◽

Maternity Care ◽

Shared Decision ◽

Intrapartum Care ◽

Care Needs ◽

Traumatic Birth ◽

Traumatic Childbirth ◽

Childbirth Experiences

Objective: This study aims to explore women’s traumatic childbirth experiences in order to make maternity care professionals more aware of women’s intrapartum care needs to prevent traumatic experiences. Methods: A qualitative exploratory study with a constant comparison/ grounded theory design was performed. Thirty-six interviews were conducted with women who had given birth in a Dutch birth setting. Findings: Four themes, playing a profound role in the occurrence of traumatic birth experiences, emerged: 1 Midwife-LED care – Maternity care professionals’ unilateral decision making during intrapartum care. 2. Alienation – Women’s experiences of feeling distant and estranged from the childbirth event and the experience. 3. Situatedness – The difference of the impact of interventions in situations when complications or emergencies are present in contrast to when interventions are performed without an emergency reason. 4. Discrepancies - Paradoxes between expectations (ought self) and reality (actual self) - on an interpersonal (woman) and intrapersonal (woman-midwife) level. Implications for practice: Intrapartum care needs to include informed-consent and shared-decision making. Practitioners need to continuously evaluate if the woman is consistently part of her own childbearing process. Practitioners need to provide personalised care, make an effort to explain (emergency) situations, be conscious of their non-verbal communication and maintain an ongoing dialogue with the woman. Conclusion: Intrapartum care can be adapted, adopting a woman-centred approach, in order to prevent women’s traumatic childbirth experiences. This study can serve as a valuable assistance for maternity services, midwifery practice, research and for developing guidance in the field of midwifery practitioners’ education. Keywords: Traumatic birth experience, Maternity care, Intrapartum care, Informed-consent, Shared-decision making, Woman-centred care, Qualitative research.

Download Full-text

Needs of parents and professionals to improve shared decision-making in interprofessional maternity care practice: A qualitative study

Birth ◽

10.1111/birt.12379 ◽

2018 ◽

Vol 45 (3) ◽

pp. 245-254 ◽

Cited By ~ 10

Author(s):

Joyce Molenaar ◽

Irene Korstjens ◽

Marijke Hendrix ◽

Raymond de Vries ◽

Marianne Nieuwenhuijze

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Shared Decision Making ◽

Maternity Care ◽

Care Practice ◽

Shared Decision

Download Full-text

Are We Involving Patients in Shared Decision-Making in Young Adult Hip Surgery? A Systematic Review of Patient Engagement Initiatives in Hip Preservation

Journal of Patient Experience ◽

10.1177/2374373520956870 ◽

2020 ◽

Vol 7 (6) ◽

pp. 920-924

Author(s):

Aaron Alokozai ◽

David N Bernstein ◽

Linsen T Samuel ◽

Atul F Kamath

Keyword(s):

Systematic Review ◽

Decision Making ◽

Young Adults ◽

Shared Decision Making ◽

Patient Engagement ◽

Decision Aids ◽

Future Research ◽

Shared Decision ◽

Call To Action ◽

Hip Disease

There are limited published studies on patient engagement, including shared decision-making, in adolescents and young adults with complex congenital or post-traumatic hip disorders. Despite the limited number of papers, we aim to clearly summarize what is currently available in the literature using a systematic review approach. We hope this serves as a call to action and catalyst for more work in this field. Future research must focus on awareness of what matters most to patients (values), and the development, implementation, and barriers to the use of decision aids and patient engagement optimization specific to hip disease in young adults.

Download Full-text