scholarly journals An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study

10.2196/13321 ◽  
2019 ◽  
Vol 8 (10) ◽  
pp. e13321 ◽  
Author(s):  
Samira Abbasgholizadeh Rahimi ◽  
Patrick M Archambault ◽  
Vardit Ravitsky ◽  
Marie-Eve Lemoine ◽  
Sylvie Langlois ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Decision Model ◽  
Prenatal Screening ◽  
Phase 1 ◽  
Prenatal Testing ◽  
Descriptive Statistics ◽  
Mixed Methods Study ◽  
Shared Decision ◽  
Hierarchy Process

BackgroundDecisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology.ObjectiveIn this mixed methods study, we aim to (1) assess women’s needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness.MethodsIn phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants’ attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics.ResultsRecruitment for phase 1 will begin in 2019. We expect results to be available in 2021.ConclusionsThis study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team.International Registered Report Identifier (IRRID)DERR1-10.2196/13321

scholarly journals An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Samira Abbasgholizadeh Rahimi ◽  
Patrick M Archambault ◽  
Vardit Ravitsky ◽  
Marie-Eve Lemoine ◽  
Sylvie Langlois ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Decision Model ◽  
Prenatal Screening ◽  
Phase 1 ◽  
Prenatal Testing ◽  
Descriptive Statistics ◽  
Mixed Methods Study ◽  
Shared Decision ◽  
Hierarchy Process

BACKGROUND Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. OBJECTIVE In this mixed methods study, we aim to (1) assess women’s needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. METHODS In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants’ attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. RESULTS Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. CONCLUSIONS This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team.

Web-based Training for Nurses on Shared Decision-Making and Prenatal Screening for Down Syndrome: a Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Alex Poulin Herron ◽  
Titilayo Tatiana Agbadje ◽  
Sabrina Guay-Bélanger ◽  
Gérard Ngueta ◽  
Geneviève Roch ◽  
...  
Keyword(s):  
Decision Making ◽  
Down Syndrome ◽  
Pregnant Women ◽  
Training Program ◽  
Prenatal Screening ◽  
Intervention Group ◽  
Control Group ◽  
Intention To Use ◽  
Shared Decision ◽  
Web Based

BACKGROUND Background: Nurses provide maternity care and thus play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision making (SDM) training program for health professionals focusing on Down syndrome screening decisions. OBJECTIVE Objective: We assessed the impact of a SDM training program on nurses’ intention to use a decision aid with pregnant women deciding about prenatal screening for Down syndrome. METHODS Methods: In this 2-arm parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were conveniently allocated either to the intervention group (web-based SDM training program that included prenatal screening) or to the control group (web-based training program focusing on prenatal screening alone, with no SDM content). The primary outcome was intention to use a decision aid. Secondary outcomes were psychosocial variables of intention (e.g. social influence), as well as knowledge, satisfaction, acceptability, perceived usefulness and reaction to the pedagogical approach. All outcomes were self-assessed through online questionnaires including space for written comments. No blinding was performed. We used Student's t test and Fisher's exact test to compare continuous and categorical variables between groups. RESULTS Results: Of 57 participants assessed for eligibility, 40 were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the training program. Mean age of participants was 41 years (SD 9). Most were women (97.5%), Caucasian (95%), clinical nurses (70%), and had completed a baccalaureate degree (65%). Post-intervention, the mean score of intention was 6.3 (5.9; 6.7) for the intervention group and 6.0 (5.42; 6.64) for the control group. The difference in intention score and other psychosocial variables score between groups was not statistically significant. Knowledge scores about SDM were significantly different (79% in the intervention group, 64% in the control group, p=0.009). There was no significant difference in overall satisfaction [4.4 (SD 0.7) in the intervention group and 4.5 (SD 0.9)] in the control group and perceived usefulness [4.6 (SD 0.4) in the intervention group and 4.4 (SD 0.5)] in the control group. Acceptability of the training program showed a statistically significant difference [4.6 (SD 0.4) in the intervention group and 4.3 (SD 0.4) in the control group; p=0.02] as well as reaction to the pedagogical approach [4.7 (SD 0.4) in the intervention group and 4.4 (SD 0.4) in the control group; p=0.02]. Seventeen participants also gave written comments on the training. CONCLUSIONS Conclusions: Nurses’ intention to use SDM in prenatal care is already high, with training or without, but their knowledge about SDM could be improved with SDM training. Our results will inform future strategies to implement shared decision-making among nurses. CLINICALTRIAL Trial Registration: ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288?term=NCT04162288&draw=2&rank=1

Evaluating a Web-Based Training Program for Nurses on Shared Decision-Making and Screening for Down Syndrome: Protocol for a Randomized Control Trial (Preprint)

2020 ◽  
Author(s):  
Alex Poulin Herron ◽  
Titilayo Tatiana Agbadjé ◽  
Mélissa Côté ◽  
Codjo-Djignefa Djade ◽  
Geneviève Roch ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Training Program ◽  
Decision Aid ◽  
Prenatal Screening ◽  
Control Group ◽  
Intention To Use ◽  
Shared Decision ◽  
Web Based ◽  
The Impact

BACKGROUND Pregnant women have difficulty choosing from amongst the wide variety of available prenatal screening options. To help pregnant women and their partners make informed decisions based on their values, needs, and preferences, a decision aid (DA) and a web-based shared decision making (SDM) training program for health professionals have been developed. In Canada, nurses have responsibilities regarding maternity care and thus the potential to do decision coaching on prenatal screening. However, there is a gap of knowledge concerning the effectiveness of SDM interventions in this area of nursing practice. OBJECTIVE This study aims to assess the impact of an SDM training program on nurses’ intention to use a decision aid for prenatal screening as well as their knowledge and overall appreciation of the training. METHODS This is a two-arm parallel randomized trial. Nurses working with pregnant women from the province of Quebec, and speaking in French, will be recruited online by a private survey firm. They will be randomly allocated (1:1 ratio) to either an experimental group, which will complete a web-based SDM training program for prenatal screening, or to a control group, which will complete a web-based training program focusing on prenatal screening alone. The experimental intervention consists of a three hour web-based and fully automated training activity hosted on the University Laval platform and has four modules: 1) SDM; 2) Down syndrome prenatal screening; 3) DA; and 4) Communication between healthcare professionals and the patient. For the control group, the topic of SDM in Module 1 has been replaced with “Context and history of prenatal screening” and the topic of DA in Module 3 has been replaced with “Consent in prenatal screening.” In addition to sociodemographic questions using a self-administered questionnaire with closed ended questions, we will assess 1) intention to use a DA in prenatal screening clinical practice; 2) knowledge; 3) satisfaction with the training; 4) acceptability; and 5) perceived usefulness. The randomization will be done by a predetermined sequence and include 36 nurses. Participants and researchers will be blinded. Intention to use DA will be assessed by a Student t test and bivariate and multivariate analysis will be performed to assess knowledge and overall appreciation of the training. RESULTS This study is ongoing and results will be available at the end of 2020 CONCLUSIONS This study results will inform on the impact of an SDM training program on nurses’ intention to use a decision aid for prenatal screening as well as their knowledge and overall appreciation of the training. It will also provide feedback on ways to upgrade the SDM training program, if needed. CLINICALTRIAL ClinicalTrials.gov ID NCT04162288

scholarly journals Effect of Shared Decision-making on Anxiety of Women Recommended for Prenatal Screening Tests in Southeast of Iran

2020 ◽  
Author(s):  
Zahra Moudi ◽  
Raheleh Jam ◽  
Hossein Ansari ◽  
Mostafa Montazer Zohour
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Shared Decision Making ◽  
Prenatal Screening ◽  
Intervention Group ◽  
Screening Tests ◽  
Control Group ◽  
Shared Decision ◽  
Level Of Education ◽  
University Level

Objective: To study the effect of shared decision-making (SDM) on the anxiety of women who were recommended for prenatal screening tests. Materials and methods: This quasi-experimental study was conducted on a total of 200 pregnant women who referred to the health centers of Zahedan, Iran, for prenatal care within April 7 to September 7, 2019. The control group received routine care, and the intervention group attended a session based on SDM. The demographic characteristics form and Spielberger Six-item State-Trait Anxiety Inventory were filled out before and immediately after the counseling, as well as before receiving the results of maternal serum biochemical markers. Results: No statistically significant effect of SDM on anxiety was reported between the control and intervention groups immediately after the counseling session (P=0.46). However, the obtained data showed that the mean value of anxiety scores (16.52±3.06) was higher among the women in the intervention group than that reported for the control group (13.80±3.55) on the day before receiving the results of the blood tests (P<0.001). Nevertheless, logistic regression analysis showed only women with a university level of education were likely to have higher anxiety scores than women with lower educational levels (AOR=10.60; 95% CI: 2.07-54.24; P=0.005). Conclusion: Offering prenatal screening can cause a slight increase in the level of anxiety among women with a university level of education. Therefore, it is required to implement supportive strategies to help high-risk pregnant women in coping with anxiety.  

Approach to dyspnoea in pregnancy in the COVID-19 era

2020 ◽  
Vol 19 (4) ◽  
pp. 230-234
Author(s):  
Anita Banerjee ◽  
◽  
Lindsay A Arrandale ◽  
Srividhya Sankaran ◽  
Guy W Glover ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Correct Diagnosis ◽  
Case Series ◽  
Differential Diagnoses ◽  
Shared Decision ◽  
First Case ◽  
Compromise Design ◽  
A Current ◽  
In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

Desirable features in a decision aid for prenatal screening – what do pregnant women and their partners think? A mixed methods pilot study

2020 ◽  
Author(s):  
Titilayo Tatiana Agbadje ◽  
Samira Abbasgholizadeh Rahimi ◽  
Mélissa Côté ◽  
Andrée-Anne Tremblay ◽  
Mariama Penda Diallo ◽  
...  
Keyword(s):  
Decision Making ◽  
Down Syndrome ◽  
Mixed Methods ◽  
Pilot Study ◽  
Pregnant Women ◽  
Technology Acceptance ◽  
Decision Aid ◽  
Prenatal Screening ◽  
Values Clarification ◽  
Quebec City

Abstract Background To help pregnant women and their partners make informed value-congruent decisions about Down syndrome prenatal screening, our team developed two successive versions of a decision aid (DAv2017 and DAv2014). We aimed to assess pregnant women and their partners’ perceptions of the usefulness of the two DAs for preparing for decision making, their relative acceptability and their most desirable features. Methods This is a mixed methods pilot study. We recruited participants of study (women and their partners) when consulting for prenatal care in three clinical sites in Quebec City. To be eligible, women had to: (a) be at least 18 years old; (b) be more than 16 weeks pregnant; or having given birth in the previous year and (c) be able to speak and write in French or English. Both women and partners were invited to give their informed consent. We collected quantitative data on the usefulness of the DAs for preparing for decision making and their relative acceptability. We developed an interview grid based on the Technology Acceptance Model and Acceptability questionnaire to explore their perceptions of the most desirable features. We performed descriptive statistics and deductive analysis. Results Overall, 23 couples and 16 individual women participated in the study. The majority of participants were between 25 and 34 years old (79% of women and 59% of partners) and highly educated (66.7% of women and 54% of partners had a university-level education). DAv2017 scored higher for usefulness for preparing for decision making (86.2 ± 13 out of 100 for DAv2017 and 77.7 ± 14 for DAv2014). For most dimensions, DAv2017 was more acceptable than DAv2014 (e.g. the amount of information was found “just right” by 80% of participants for DAv2017 against 56% for DAv2014). However, participants preferred the presentation and the values clarification exercise of DAv2014. In their opinion, neither DA presented information in a completely balanced manner. They suggested adding more information about raising Down syndrome children, replacing frequencies with percentages, different values clarification methods, and a section for the partner. Conclusions A new user-centered version of the prenatal screening DA will integrate participants’ suggestions to reflect end users’ priorities.

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