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Van der Voorden M, Franx A, Ahaus K. Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study. BMC Health Serv Res 2024; 24:700. [PMID: 38831446 PMCID: PMC11149232 DOI: 10.1186/s12913-024-11154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Recent research within the context of Obstetrics shows the added value of patient participation in in-hospital patient safety. Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department. METHODS This study was conducted in the Obstetrics Department of a tertiary academic center. An explorative qualitative interview study included sixteen interviews with professionals (N = 8) and patients (N = 8). The actions to mitigate the negative effects of patient participation in patient safety, were analyzed and classified using a deductive approach. RESULTS Eighteen actions were identified that mitigated the negative effects of patient participation in patient safety within an Obstetrics department. These actions were categorized into five themes: 'structure', 'culture', 'education', 'emotional', and 'physical and technology'. These five categories reflect the current approach to improving patient safety which is primarily viewed from the perspective of professionals rather than of patients. CONCLUSIONS Most of the identified actions are linked to changing the culture to generate more patient-centered care and change the current reality, which looks predominantly from the perspective of the professionals and too little from that of the patients. Furthermore, none of the suggested actions fit within a sixth anticipated category, namely, 'politics'. Future research should explore ways to implement a patient-centered care approach based on these actions. By doing so, space, money and time have to be created to elaborate on these actions and integrate them into the organizations' structure, culture and practices.
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Affiliation(s)
- Michael Van der Voorden
- Department of Obstetrics and Gynaecology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Kees Ahaus
- Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, Netherlands
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Yu L, Sun X, Gong J, Liu M, Yu S, Liu L. Effectiveness of shared decision-making for mode of delivery after caesarean section: A systematic review and meta-analysis of randomized controlled trials. J Clin Nurs 2024. [PMID: 38803111 DOI: 10.1111/jocn.17291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
AIM To review the content, format and effectiveness of shared decision-making interventions for mode of delivery after caesarean section for pregnant women. DESIGN Systematic review and meta-analysis. METHODS Six databases (PubMed, Web of science Core Collection, Cochrance Network, Embase, CINAHL, PsycINFO) were searched starting at the time of establishment of the database to May 2023. Following the PRISMAs and use Review Manager 5.3 software for meta-analysis. Two review authors independently assessed the quality of the studies using the risk of bias 2 tool. The protocol was registered in PROSPERO (CRD42023410536). RESULTS The search strategy obtained 1675 references. After abstract and full text screening, a total of seven studies were included. Shared decision-making interventions include decision aids and counselling that can help pregnant women analyse the pros and cons of various options and help them make decisions that are consistent with their values. The pooled results showed that shared decision-making intervention alleviated decisional conflicts regarding mode of delivery after caesarean section, but had no effect on knowledge and informed choice. CONCLUSION The results of our review suggest that shared decision-making is an effective intervention to improve the quality of decision-making about the mode of delivery of pregnant women after caesarean section. However, due to the low quality of the evidence, it is recommended that more studies be conducted in the future to improve the quality of the evidence. CORRELATION WITH CLINICAL PRACTICE This systematic review and meta-analysis provides evidence for the effectiveness of shared decision-making for mode of delivery after cesarean section and may provide a basis for the development of intervention to promote the participation of pregnant women in the decision-making process.
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Affiliation(s)
- Lin Yu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Xiaoting Sun
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Jianmei Gong
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Man Liu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Shengmiao Yu
- Outpatient Department, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lei Liu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
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Henshall BI, Grimes HA, Davis J, East CE. What is 'physiological birth'? A scoping review of the perspectives of women and care providers. Midwifery 2024; 132:103964. [PMID: 38432119 DOI: 10.1016/j.midw.2024.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/07/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
PROBLEM Physiological birth was defined by the World Health Organization in 1997, however, clinical practices in childbirth have changed considerably since this time. BACKGROUND Ambiguous terms in healthcare such as 'physiological birth' may cause confusion amongst care providers and consumers. AIM To identify what is known about physiological birth, and how perceptions of physiological birth manifest in current literature. METHODS This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR checklist. Four databases were searched using keywords relating to physiological birth. Relevant studies were identified using agreed criteria, and data were extracted and synthesised. RESULTS A total of 24 studies met the inclusion criteria for this review. Three connected factors were identified: (1) Physiological birth in a risk-averse system, (2) Dominant voices in birth, and (3) Lack of exposure to physiological birth. No unified universal definition of physiological birth was identified in the literature. DISCUSSION 'Physiological birth' as a term lacks consistency. A risk-averse healthcare system could be a barrier to physiological birth. Dominant voices in the birthing space can dictate the way birth occurs. Lack of exposure to physiological birth may diminish the acquisition and maintenance of important skills and knowledge among care providers. Recognising the factors important to women could lead to a positive birth experience. CONCLUSION Excluding a woman's subjective experience from health professionals' understanding of physiological birth increases the likelihood of risk management being the paramount objective in clinical decision-making. We propose it is timely to align clinical understanding of physiological birth with midwifery's woman-centred professional philosophy.
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Affiliation(s)
- Brooke I Henshall
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Mercy Hospital for Women, Mercy Health Pty Ltd, Heidelberg Victoria, Australia.
| | - Heather A Grimes
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Department of Nursing & Midwifery, Dames Cook University, James Cook University, Townsville, Queensland, Australia
| | - Jennifer Davis
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia
| | - Christine E East
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Mercy Hospital for Women, Mercy Health Pty Ltd, Heidelberg Victoria, Australia
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Hardman K, Davies A, Demetri A, Clayton G, Bakhbakhi D, Birchenall K, Barnfield S, Fraser A, Burden C, McGuinness S, Miller R, Merriel A. Maternity healthcare professionals' experiences of supporting women in decision-making for labour and birth: a qualitative study. BMJ Open 2024; 14:e080961. [PMID: 38684269 PMCID: PMC11057275 DOI: 10.1136/bmjopen-2023-080961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/05/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To explore and characterise maternity healthcare professionals' (MHCPs) experience and practice of shared decision-making (SDM), to inform policy, research and practice development. DESIGN Qualitative focus group study. SETTING Large Maternity Unit in the Southwest of England. PARTICIPANTS MHCPs who give information relating to clinical procedures and pregnancy care relating to labour and birth and are directly involved in decision-making conversations were purposively sampled to ensure representation across MHCP groups. DATA COLLECTION A semistructured topic guide was used. DATA ANALYSIS Reflexive thematic analysis was undertaken. RESULTS Seven focus groups were conducted, comprising a total of 24 participants (3-5 per group). Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve SDM. There were communication challenges with women who did not speak English. Three controversies were explored: the role of prior clinical experience, the validity of informed consent when women were in pain and during life-threatening emergencies and instances where women declined medical advice. CONCLUSIONS We found that MHCPs are committed to SDM but need better support to deliver it. Structured processes including Core Information Sets, communication skills training and decision support aids may help to consistently deliver SDM in maternity care.
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Affiliation(s)
- Kitty Hardman
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Andrew Demetri
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | - Gemma Clayton
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Danya Bakhbakhi
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
| | | | | | - Abigail Fraser
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Christy Burden
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | | | | | - Abi Merriel
- Centre for Academic Women's Health, University of Bristol, Bristol, UK
- Institute of Life Course and Medical Sciences, Department of Women's and Children's Health, Centre for Women's Health Research, University of Liverpool, Liverpool, UK
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Park M, Doan TTT, Jung J, Giap TTT, Kim J. Decision aids for promoting shared decision-making: A review of systematic reviews. Nurs Health Sci 2024; 26:e13071. [PMID: 38356102 DOI: 10.1111/nhs.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/03/2023] [Accepted: 12/03/2023] [Indexed: 02/16/2024]
Abstract
In the context of shared decision-making (SDM), experts have advocated the use of validated decision aids (DAs) as valuable tools for facilitating SDM in various healthcare scenarios. This comprehensive review attempts to analyze a vast corpus of DA research by performing thorough searches across four prominent databases (PubMed, CINAHL, Embase, and Web of Science). Independent reviewers selected relevant reviews, extracted data, and assessed review quality using the AMSTAR II tool. A total of 34 systematic reviews were identified and evaluated in this review, encompassing a wide range of outcomes associated with using DAs. These outcomes include patient knowledge, patient involvement in SDM, decision conflict, decision regret, satisfaction, and adherence. In addition, DAs positively affect healthcare provider outcomes by increasing satisfaction, reducing decision conflicts, and lengthening clinical consultations. This review highlights the need for additional research in specific contexts such as long-term care, mental health, and reproductive health to better understand the benefits and challenges of implementing DAs in these settings. Such research can contribute to the improvement of SDM practices and patient-centered care.
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Affiliation(s)
- Myonghwa Park
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Thao Thi-Thu Doan
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- Faculty of Nursing, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jihye Jung
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Thi-Thanh-Tinh Giap
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- College of Health Sciences, Vin University, Hanoi, Vietnam
| | - Jinju Kim
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
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Capmas P, Panjo H, Artignan J, Babelhadj A, Benoist I, Decouzon J, Jarrige C, Leglise M, Renoncet V, Pelletier-Fleury N. Women's preferences for less active ectopic pregnancy treatment: A discrete choice experiment. Eur J Obstet Gynecol Reprod Biol 2024; 292:175-181. [PMID: 38035866 DOI: 10.1016/j.ejogrb.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
RESEARCH QUESTION Shared decision-making has become a hallmark of quality care and is increasingly spotlighted in practice guidelines. Little is known about women's views for treatment of less active ectopic pregnancy. What are the preferences of women for less active ectopic pregnancy treatment-related attributes? DESIGN A discrete choice model with 8 attributes depicting ectopic pregnancy treatment including varying levels of first-line treatment effectiveness, length of hospitalization, cost, length of sick leave, of convalescence, need for surgical management, for emergency care during convalescence and for tube removal was used. Childbearing aged women, i.e. those who might experience an ectopic pregnancy in the future, were recruited. They were asked to choose between hypothetical treatments in 18 choice tasks with different levels of all treatment attributes. A conditional logit McFadden's choice model was performed. The main outcome measure was preference weights for less active ectopic pregnancy treatment-related attributes. RESULTS A total of 5770 observations from 178 women were analysed. The attributes displaying the highest marginal impacts on women's decisions included: higher rate of first-line treatment effectiveness, lower rate of tube removal, lower rate of surgical management, shorter length of hospitalization and, to a lesser extent, but still significant, shorter length of convalescence, absence of risk of emergency care during convalescence and lower cost. CONCLUSIONS Trade-offs made by women between the attributes of less active ectopic pregnancy treatment suggest that no treatment option, either medical or surgical, is an obvious preferred option. These results encourage the promotion of shared decision-making.
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Affiliation(s)
- Perrine Capmas
- Centre of Research in Epidemiology and Population Health (CESP), UMR1018, Inserm, Paris Saclay University, Hôpital Paul Brousse, 16 Avenue Paul Vaillant Couturier F-94816 Villejuif, France; Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 78 avenue du Général Leclerc, F-94276 Le Kremlin Bicetre, France; GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France.
| | - Henri Panjo
- Centre of Research in Epidemiology and Population Health (CESP), UMR1018, Inserm, Paris Saclay University, Hôpital Paul Brousse, 16 Avenue Paul Vaillant Couturier F-94816 Villejuif, France
| | - Juliette Artignan
- GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
| | - Aicha Babelhadj
- GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
| | - Inès Benoist
- GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
| | - Julie Decouzon
- GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
| | - Claire Jarrige
- GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
| | - Mylène Leglise
- GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
| | - Valérie Renoncet
- GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
| | - Nathalie Pelletier-Fleury
- Centre of Research in Epidemiology and Population Health (CESP), UMR1018, Inserm, Paris Saclay University, Hôpital Paul Brousse, 16 Avenue Paul Vaillant Couturier F-94816 Villejuif, France; GyneSpri Participatory Research Group, Association GyneSpri, 28 rue Anatole France, 94300 Vincennes, France
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Duane M, Martinez V, Berry M, Gilpatrick S, Manhart MD. Evaluation of a fertility awareness-based shared decision-making tool part 2: Patient experiences. PEC INNOVATION 2023; 2:100169. [PMID: 37384150 PMCID: PMC10294094 DOI: 10.1016/j.pecinn.2023.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023]
Abstract
Objective To assess patient experiences using a Shared Decision-Making (SDM) Tool for fertility awareness-based methods (FABMs) of family planning. Methods The study employed a prospective crossover design to evaluate impact of the SDM tool compared to usual practice when discussing FABMs with patients. Patients completed pre- and post-office visit surveys and an online survey six months later. The primary outcomes evaluated the effect of the SDM tool on patient satisfaction and FABM continuity of use rates. Results There was no significant difference in likelihood of changing family planning methods immediately after the office visit; however, by six months a significantly larger proportion of patients had started or changed FABMs in the experimental group (52%, 34/66) compared to the control group (36%, 24/66) (p = 0.04). Significantly more patients who used the tool and changed their FABM after their visit reported increased satisfaction with their FABM compared to control (50% vs. 17%, p = 0.022). Conclusions Use of the SDM tool increased persistent use of and satisfaction with chosen FABMs at six months. Innovations The novel SDM tool can enhance patients' understanding and facilitate the selection of a more suitable method leading to increased satisfaction.
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Affiliation(s)
| | | | - Meghan Berry
- FACTS, 1020 Kearny St NE, Washington, DC 20017, USA
| | | | - Michael D. Manhart
- Fertility Science Institute, Couple to Couple League International, 5440 Moeller Avenue Suite 149, Cincinnati, OH 45212, USA
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Dason ES, Drost L, Greenblatt EM, Scheer A, Han J, Doshi T, Jones CA. Patients' and providers' perspectives on the decision to undergo non-urgent egg freezing: a needs assessment. BMC Womens Health 2023; 23:594. [PMID: 37953253 PMCID: PMC10641979 DOI: 10.1186/s12905-023-02743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 10/29/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Previous research has demonstrated that patients have difficulty with the decision to undergo non-urgent egg freezing (EF). This study aimed to investigate the decisional difficulties and possible decisional support mechanisms for patients considering EF, and for their providers. METHODS This qualitative study involved a needs assessment via individual interviews. Participants included patients considering EF at one academic fertility clinic and providers from across Canada who counsel patients considering EF. 25 participants were included (13 providers and 12 patients). The interview guide was developed according to the Ottawa Decision Support Framework. Interviews were transcribed, and transcripts analyzed for themes and concepts using NVIVO 12. FINDINGS Multiple factors contributing to decisional difficulty were identified, including: (1) multiple reproductive options available with differing views from patients/providers regarding their importance; (2) a decision typically made under the pressure of reproductive aging; (3) uncertainty surrounding the technology/inadequate outcome data; (4) the financial burden of EF; (5) inherent uncertainty relating to potential decision regret; and (6) differing perceptions between patients/providers regarding the role providers should play in the decision. Additionally, potential sources of decisional support were identified, including provision of basic information before and/or during initial consultation, followed by an opportunity during or after initial consultation for clarifying information and helping with value judgements. Individualized counselling based on patient values, adequate follow-up, psychosocial counselling, and peer support were also emphasized. CONCLUSIONS More decisional support for women considering EF is needed. Suggestions include a patient decision aid in conjunction with modified healthcare provider counselling, support and follow up.
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Affiliation(s)
- E Shirin Dason
- Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, Faculty of Medicine, University of Toronto, 12th floor, 123 Edward St Toronto, Ontario, M5G 1E2, Canada
| | - Leah Drost
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada.
| | - Ellen M Greenblatt
- Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, Faculty of Medicine, University of Toronto, 12th floor, 123 Edward St Toronto, Ontario, M5G 1E2, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada
| | - Adena Scheer
- Department of General Surgery, St. Michaels Hospital, Unity Health Network, Toronto, Ontario, M5B 1W8, Canada
| | - Jinglan Han
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Tanya Doshi
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada
| | - Claire A Jones
- Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, Faculty of Medicine, University of Toronto, 12th floor, 123 Edward St Toronto, Ontario, M5G 1E2, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada
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Goueth R, Darney B, Hoffman A, Eden KB. Evaluating the Acceptability and Feasibility of a Sexual Health-Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study. JMIR Form Res 2023; 7:e44170. [PMID: 37788070 PMCID: PMC10582807 DOI: 10.2196/44170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid-Healthy Sex Choices-designed to support diverse young adults with their contraceptive decision-making. OBJECTIVE This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. METHODS We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. RESULTS Participants were satisfied with the tool, rating the acceptability as "good." Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53% before vs 45% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48% vs 55%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. CONCLUSIONS Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations.
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Affiliation(s)
- Rose Goueth
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Blair Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, United States
- Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, United States
- Centro de Investigacion en Salud Poblacional (CISP), Insituto Nacional de Salud Publica (INSP), Cuernavaca, Mexico
| | - Aubri Hoffman
- Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
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Alotaibi MA, Alhowimel AS, Alodaibi FA, Aloraifi M. The Practice of Shared Decision-Making Among Physiotherapists and Patients with Musculoskeletal Conditions. J Multidiscip Healthc 2023; 16:2655-2665. [PMID: 37706183 PMCID: PMC10496844 DOI: 10.2147/jmdh.s425315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Shared decision-making (SDM) may be interpreted as a set of core values rather than as a consensus definition. This study aimed to explore how SDM between patients and physiotherapists may lead to patient satisfaction. Patients and Methods A cross-sectional study was conducted to examine the relationship between SDM and patient satisfaction. The study targeted physiotherapists and patients with musculoskeletal pain or disorders. A structured questionnaire (the nine-item Shared Decision-Making Questionnaire) was developed to show the extent to which patients felt involved in the process by scoring nine items from 0 to 5 on a six-point scale. t-tests were performed to estimate differences in SDM perceptions between patients and physiotherapists, and regression analyses were performed to estimate the best predictors of SDM. Results The questionnaire was completed by a total of 106 patients and nine physiotherapists. The demographic information of the samples was presented with frequency analysis. This study's findings demonstrate no variations in the final SDM perceptions between patients and physiotherapists, but when SDM was contrasted step-by-step (as items), many variances were discovered. These distinctions reinforce the notion that regardless of the end outcome, the process of reaching a consensus has a distinct profile depending on the type of medical care. Therapists emphasize the first steps, possibly because there is sufficient evidence to make a therapeutic decision. However, patients highlight the final steps, perhaps because the moment for a decision based on the consultation's nature is approaching. Conclusion This study demonstrates that SDM is a complex process that must be examined in multiple stages. However, in physiotherapy contexts, this process exhibits extremely different patterns, reflecting a significantly different perspective of the decision-making process.
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Affiliation(s)
- Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Aloraifi
- Salamat Medical Hospital, Department of Physiotherapy, Hail, Saudi Arabia
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Flynn AN, McAllister A, Kete C, Koelper NC, Gallop RJ, Schreiber CA, Schapira MM, Sonalkar S. Evaluation of a decision aid for early pregnancy loss: A pilot randomized controlled trial in Philadelphia, Pennsylvania. Contraception 2023; 125:110077. [PMID: 37270163 DOI: 10.1016/j.contraception.2023.110077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the effect of a decision aid on decisional conflict scale in patients choosing management for early pregnancy loss. STUDY DESIGN We conducted a pilot randomized control trial to assess the effect of the Healthwise patient decision aid on decisional conflict scale in patients with early pregnancy loss as compared with a control website. Patients 18years and older were eligible if they had an early pregnancy loss between 5 and 12 completed weeks of gestation. Participants completed surveys at baseline, poststudy intervention, after consultation, and 1week postconsultation. Surveys assessed participant scores on the decisional conflict scale (scale 0-100), knowledge, assessment of shared decision-making, satisfaction, and decision regret. Our primary outcome was the poststudy-intervention decisional conflict scale score. RESULTS From July 2020 through March 2021 we randomized 60 participants. After the intervention, the median decisional conflict scale score for the control group was 10 [0-30] and 0 [0-20] for the intervention group (p = 0.17). When assessing the decisional conflict scale subscales postintervention, the informed subscale for the control group was 16.7 [0-33.3] as opposed to 0 [0] for the patient decision aid group (p = 0.003). Knowledge remained significantly higher in the experimental arm from the postintervention to the 1-week follow-up. We found no differences between groups when assessing our other metrics. CONCLUSIONS Use of a validated decision aid did not result in statistically significant differences in the total decisional conflict scale scores as compared with the control. Participants allocated to the intervention were more informed postintervention and had consistently higher knowledge scores. IMPLICATIONS Use of a validated decision aid prior to early pregnancy loss management consultation did not affect overall decisional conflict but resulted in improved knowledge.
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Affiliation(s)
- Anne N Flynn
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Arden McAllister
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Corinne Kete
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nathanael C Koelper
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert J Gallop
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Marilyn M Schapira
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarita Sonalkar
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Hsu MY, Chen YS, Chen YC, Wu YL. Nurse-led coaching of shared decision-making for wound treatment of pressure injury: A pilot study of a randomized trial. Tzu Chi Med J 2023; 35:260-266. [PMID: 37545793 PMCID: PMC10399837 DOI: 10.4103/tcmj.tcmj_256_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/26/2022] [Accepted: 02/20/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives International guidelines for managing pressure injury (PI) and ulcers recommend that family members and caregivers should be involved in making decisions for appropriate wound care. However, the effect of shared decision-making (SDM) in the context of PI remains unknown. This study investigated the efficacy of nurse-led medical SDM for PI treatment. Materials and Methods We constructed a patient decision aid (PDA) for PI treatment on the basis of nursing evidence. Subsequently, we conducted a pilot randomized controlled trial to evaluate the efficacy of SDM compared with that of usual care (control group, [CG]) for PI treatment. Participants with stage 3, stage 4, or unstageable PI were included and randomized into two groups. In the SDM group (SDMG), 10 participants received the SDM intervention for PI before treatment. All participants were followed up for 4 weeks. Primary outcomes were measured using the nine-item SDM Questionnaire (SDM-Q-9) and Decisional Conflict Scale (DCS). Secondary outcomes included wound size and cost of wound management. Results The expert validity (medical professors and general population) of the PDA designed for PI was measured, and the content validity index was 0.96-0.97. A total of 20 participants were enrolled (10 received SDM and 10 received usual care). The mean age of the participants was 55.7 ± 8.8 years. No significant difference in baseline characteristics (sex, age, staging, or wound area) was observed between the two groups. The SDMG had higher SDM-Q-9 (P < 0.001) and DCS (P < 0.01) scores than did the CG. For the secondary outcomes, the SDMG had a decreased change of wound size and lower wound management costs than did the CG; nevertheless, the differences were not statistically significant. Conclusion We constructed a PDA for PI treatment, which can be applied in clinical care. The pilot test results revealed that the participants had a lower cost related wound treatment and decreasing wound size in SDMG than CG after the intervention of SDM-PI for 4 weeks. In the future, clinical studies should conduct large-scale randomized trials based on the results of this pilot study.
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Affiliation(s)
- Mei-Yu Hsu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Sin Chen
- Department of Nursing, Kuang Tien General Hospital, Taichung, Taiwan
| | - Ying-Chun Chen
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Lin Wu
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Vu PD, Malik A, Cohen AS, Bansal V, Cowan MR, Blazek GM, Champagne-Langabeer T. Shared Decision Making in Acute Pain Management in Patients with Opioid Use Disorder: A Scoping Review. J Clin Med 2023; 12:jcm12103555. [PMID: 37240661 DOI: 10.3390/jcm12103555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The treatment of acute pain over the years has changed with increasing alternative therapies and increased scrutiny of opioid prescriptions. Shared Decision Making (SDM) has become a vital tool in increasing patient engagement and satisfaction in treatment decisions. SDM has been successfully implemented in the management of pain in a variety of settings; however, information regarding the use of SDM for treating acute pain in patients with a history of opioid use disorder (OUD) remains scarce. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR), we conducted a review to understand how SDM is used in acute pain management in patients with OUD. We searched Medline, Embase, CINAHL, and PsychInfo databases for relevant articles. Articles were screened and SDM outcomes of eligible articles were charted. The results were grouped by sub-theme based on a 1997 SDM model. There were three original research studies and one quality improvement study. The remaining articles were split evenly between reviews and reviews of clinical guidelines. Four themes emerged from the review: prior judgment and stigma related to OUD, trust and sharing of information, clinical tools, and interprofessional teams. This scoping review consolidated and expounded the current literature on SDM in the management of acute pain in patients with OUD. More work is needed to address prior judgments by both providers and patients and to build greater dialogue. Clinical tools may aid this process as well as the involvement of a multidisciplinary team.
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Affiliation(s)
- Peter D Vu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - A Sarah Cohen
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, 7000 Fannin, Houston, TX 77030, USA
| | - Vishal Bansal
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Morgan R Cowan
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Gregory M Blazek
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Tiffany Champagne-Langabeer
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, 7000 Fannin, Houston, TX 77030, USA
- Tiffany Champagne-Langabeer, UTHealth Houston, 7000 Fannin St., Suite 600, Houston, TX 77030, USA
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16
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Foggin H, Metcalfe R, Hutcheon JA, Bansback N, Burrows J, Karacebeyli E, Shivananda S, Boutin A, Liauw J. Understanding what patients and physicians need to improve their decision-making about antenatal corticosteroids in late preterm gestation: a qualitative framework analysis. CMAJ Open 2023; 11:E466-E474. [PMID: 37220957 DOI: 10.9778/cmajo.20220139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND It is unclear whether the benefits of administration of antenatal corticosteroids in late preterm gestation outweigh its harms. We sought to understand whether patients and physicians need increased support to decide whether to administer antenatal corticosteroids in late preterm gestation, and their informational needs and preferences for decision-making roles related to this intervention; we also wanted to know if creation of a decision-support tool would be useful. METHODS We conducted individual, semistructured interviews with pregnant people, obstetricians and pediatricians in Vancouver, Canada, in 2019. Using a qualitative framework analysis method, we coded, charted and interpreted interview transcripts into categories that formed an analytical framework. RESULTS We included 20 pregnant participants, 10 obstetricians and 10 pediatricians. We organized codes into the following categories: informational needs to decide whether to administer antenatal corticosteroids; preferences for decision-making roles regarding this treatment; the need for support to make this treatment decision; and the preferred format and content of a decision-support tool. Pregnant participants wanted to be involved in decision-making about antenatal corticosteroids in late preterm gestation. They wanted information on the medication, respiratory distress, hypoglycemia, parent-neonate bonding and long-term neurodevelopment. There was variation in physician counselling practices, and in how patients and physicians perceived the balance of treatment harms and benefits. Responses suggested a decision-support tool may be useful. Participants desired clear descriptions of risk magnitude and uncertainty. INTERPRETATION Pregnant people and physicians would likely benefit from increased support to consider the harms and benefits of antenatal corticosteroids in late preterm gestation. Creation of a decision-support tool may be useful.
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Affiliation(s)
- Hannah Foggin
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Rebecca Metcalfe
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Nick Bansback
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jason Burrows
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Eda Karacebeyli
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Sandesh Shivananda
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Amelie Boutin
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jessica Liauw
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
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17
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Drost L, Dason ES, Han J, Doshi T, Scheer A, Greenblatt EM, Jones CA. Patients' and providers' perspectives on non-urgent egg freezing decision-making: a thematic analysis. BMC Womens Health 2023; 23:49. [PMID: 36755254 PMCID: PMC9906951 DOI: 10.1186/s12905-023-02189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The decision to undergo non-urgent egg freezing (EF) is complex for patients and providers supporting them. Though prior studies have explored patient perspectives, no study has also included the separate perspectives of providers. METHODS This qualitative study involved semi-structured individual interviews exploring the decision to undergo EF. Participants included patients considering EF at one academic fertility clinic and providers who counsel patients about EF from across Canada. Data analysis was accomplished using thematic analysis. Data saturation was met after interviewing 13 providers and 12 patients. FINDINGS Four themes were identified and explored, illuminating ways in which patients and providers navigate decision-making around EF: (1) patients viewed EF as a 'back-up plan' for delaying the decision about whether to have children, while providers were hesitant to present EF in this way given the uncertainty of success; (2) providers viewed ovarian reserve testing as essential while patients believed it unnecessarily complicated the decision; (3) patients and providers cited a need for change in broader societal attitudes regarding EF since social stigma was a significant barrier to decision-making; and (4) commonality and peer support were desired by patients to assist in their decision, although some providers were hesitant to recommend this to patients. CONCLUSIONS In conclusion, the decision to undergo EF is complex and individual patient values play a significant role. In some areas, there is disconnect between providers and patients in their views on how to navigate EF decision-making, and these should be addressed in discussions between providers and patients to improve shared decision-making.
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Affiliation(s)
- Leah Drost
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON, M5G 1X5, Canada.
| | - E. Shirin Dason
- grid.17063.330000 0001 2157 2938Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, University of Toronto, 12Th Floor, 123 Edward St, Toronto, ON M5G 1E2 Canada
| | - Jinglan Han
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.25152.310000 0001 2154 235XDepartment of Obstetrics &, Gynecology University of Saskatchewan, Saskatoon, SK S7N 0W8 Canada
| | - Tanya Doshi
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - Adena Scheer
- grid.415502.7Department of General Surgery, St. Michaels Hospital, Unity Health Network, Toronto, ON M5B 1W8 Canada
| | - Ellen M. Greenblatt
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.17063.330000 0001 2157 2938Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, University of Toronto, 12Th Floor, 123 Edward St, Toronto, ON M5G 1E2 Canada
| | - Claire A. Jones
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.17063.330000 0001 2157 2938Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, University of Toronto, 12Th Floor, 123 Edward St, Toronto, ON M5G 1E2 Canada
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Kalpakjian CZ, Haapala HJ, Ernst SD, Orians BR, Barber ML, Mulenga L, Bolde S, Kreschmer JM, Parten R, Carlson S, Rosenblum S, Jay GM. Development and pilot test of a pregnancy decision making tool for women with physical disabilities. Health Serv Res 2023; 58:223-233. [PMID: 36401816 PMCID: PMC9836953 DOI: 10.1111/1475-6773.14103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Heidi J. Haapala
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan D. Ernst
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Lukonde Mulenga
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Shannen Bolde
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Rebecca Parten
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Carlson
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sara Rosenblum
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Gina M. Jay
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Drost LE, Stegeman M, Gerritse MBE, Franx A, Vos MC, Lamers RED, Ezendam NPM, Dam A, Schrickx J, van Wijk HF. A web-based decision aid for shared decision making in pelvic organ prolapse: the SHADE-POP trial. Int Urogynecol J 2023; 34:79-86. [PMID: 36378318 PMCID: PMC9665015 DOI: 10.1007/s00192-022-05405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Among women worldwide, pelvic organ prolapse (POP) is a common problem. There are three different treatment options for POP: pelvic floor muscle therapy, pessary treatment and prolapse surgery. As none of the three treatment options is clearly superior, shared decision making (SDM) is very important. A decision aid (DA) is known to facilitate patient participation and SDM. We hypothesise that the use of a web-based DA for POP increases patients' satisfaction with information and care and reduces decisional conflict. METHODS This two-arm, multicentre, cluster randomised controlled trial was performed in women with POP in five different Dutch hospitals. The control group received usual care (UC) and the intervention group received the DA in addition to UC. Primary outcome measures were satisfaction with treatment decision making and satisfaction with information. Analyses were performed using independent sample t tests, Chi-squared tests, and multilevel linear regression analyses. RESULTS Between the DA group (n=40) and the UC group (n=56) no differences were found concerning patients' satisfaction with information, with scores of 45.63 and 46.14 out of 50 respectively (p=0.67). Also, no differences were found concerning the perceived role in decision making, as patients scored 46.83 in the DA group and 46.41 in the UC group, out of a maximum of 54 (n=0.81). CONCLUSIONS No differences were found concerning patients' satisfaction with information and treatment decision making between the DA and UC. However, both groups scored high on the questionnaires, which suggests that the decision process is already of high quality.
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Affiliation(s)
- Larissa Esmeralda Drost
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000, LC, Tilburg, the Netherlands.
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Marjan Stegeman
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000, LC, Tilburg, the Netherlands
| | - Maria B E Gerritse
- Department of Obstetrics and Gynaecology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000, LC, Tilburg, the Netherlands
| | | | - Romy E D Lamers
- Department of Urology, UMC Utrecht, Utrecht, the Netherlands
| | - Nicole P M Ezendam
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands and Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Anika Dam
- Department of Obstetrics and Gynaecology, VieCuri Medical Center, Venlo, the Netherlands
| | - Jan Schrickx
- Department of Obstetrics and Gynaecology, Rivas Beatrix Hospital, Gorinchem, The Netherlands
| | - Heidy F van Wijk
- Department of Obstetrics and Gynaecology, Bravis Hospital, Roosendaal, The Netherlands
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Choon-Quinones M, Hose D, Kaló Z, Zelei T, Harousseau JL, Durie B, Keown P, Barnett M, Jakab I. Patient and Caregiver Experience Decision Factors in Treatment Decision Making: Results of a Systematic Literature Review of Multiple Myeloma Decision Aids. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:39-49. [PMID: 35613958 DOI: 10.1016/j.jval.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/18/2022] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Decision-aids (DAs) may facilitate shared decision-making for patients and caregivers, by providing evidence-based information to assist healthcare professionals, patients, and caregivers in making choices about aspects of care, and/or highlighting decision factors to discuss with the potential of altering the treatment decision. These decision factors may not be well integrated in DAs. METHODS A systematic literature review was conducted in the field of multiple myeloma (MM) on peer-reviewed publications, extended with a gray literature search. Data on whether and how patient and caregiver experience elements, other than survival and physical quality of life, were mentioned as decision factors in the identified MM DAs were extracted and analyzed qualitatively. RESULTS Seventy MM DAs were found and analyzed; 51% of DAs mentioned any patient non-routinely assessed experience decision factors and only 17% mentioned any caregiver-related information. One hundred and forty potential decision factors were extracted, deduplicated and categorized into the following categories: 1) financial, 2) mode of administration / transportation issues, 3) personal beliefs and values, 4) emotional and social quality of life, 5) other medical information, 6) availability of social support, 7) caregiver burden. None of the DAs presented a comprehensive framework on all seven categories of decision factors being consider when mapping patient and caregiver experience value elements in MM. CONCLUSIONS Based on available DAs, we recommend a set of patient and caregiver experience decision factors that have the potential to affect treatment choices of patients with MM, which should be included in DAs, including MM clinical guidelines.
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Affiliation(s)
| | - Dirk Hose
- Vrije Universiteit Brussel, Brussels, Belgium
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
| | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | | | - Brian Durie
- International Myeloma Foundation, Studio City, CA, USA
| | - Paul Keown
- University of British Columbia, Vancouver, BC, Canada
| | - Mike Barnett
- University of British Columbia, Vancouver, BC, Canada
| | - Ivett Jakab
- Syreon Research Institute, Budapest, Hungary
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Mitropoulou P, Grüner-Hegge N, Reinhold J, Papadopoulou C. Shared decision making in cardiology: a systematic review and meta-analysis. Heart 2022; 109:34-39. [PMID: 36007938 DOI: 10.1136/heartjnl-2022-321050] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of interventions to improve shared decision making (SDM) in cardiology with particular focus on patient-centred outcomes such as decisional conflict. METHODS We searched Embase (OVID), the Cochrane library, PubMed and Web of Science electronic databases from inception to January 2021 for randomised controlled trials that investigated the effects of interventions to increase SDM in cardiology. The primary outcomes were decisional conflict, decisional anxiety, decisional satisfaction or decisional regret; a secondary outcome was knowledge gained by the patients. RESULTS Eighteen studies which reported on at least one outcome measure were identified, including a total of 4419 patients. Interventions to increase SDM had a significant effect on reducing decisional conflict (standardised mean difference (SMD) -0.211, 95% CI -0.316 to -0.107) and increasing patient knowledge (SMD 0.476, 95% CI 0.351 to 0.600) compared with standard care. CONCLUSIONS Interventions to increase SDM are effective in reducing decisional conflict and increasing patient knowledge in the field of cardiology. Such interventions are helpful in supporting patient-centred healthcare and should be implemented in wider cardiology practice.
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Affiliation(s)
- Panagiota Mitropoulou
- Cardiology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Johannes Reinhold
- Norwich Medical School, University of East Anglia, Norwich, UK .,Department of Cardiology, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Charikleia Papadopoulou
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK .,Department of Medicine, University of Cambridge, Cambridge, UK
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Dason ES, Drost L, Greenblatt EM, Scheer AS, Han J, Sobel M, Allen L, Jacobson M, Doshi T, Wolff E, McMahon E, Jones CA. Providers' perspectives on the reproductive decision-making of BRCA-positive women. BMC Womens Health 2022; 22:506. [PMID: 36482357 PMCID: PMC9730610 DOI: 10.1186/s12905-022-02093-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Reproductive decision-making is difficult for BRCA-positive women. Our objective was to assess the complexities of decision-making and identify decisional supports for patients and providers when discussing reproductive options prior to risk-reducing salpingo-oophorectomy (RRSO). METHODS This study was of qualitive design, using data collection via semi-structured interviews conducted from November 2018 to October 2020. Individuals were included if they were identified to provide care to BRCA-positive women. In total, 19 providers were approached and 15 consented to participate. Providers were recruited from three clinics in Toronto, Ontario located at academic centers: [1] A familial ovarian cancer clinic, [2] A familial breast cancer clinic and [3] A fertility clinic, all of which treat carriers of the BRCA1/BRCA2 genetic mutation. The interview guide was developed according to the Ottawa Decision Support Framework and included questions regarding reproductive options available to patients, factors that impact the decision-making process and the role of decisional support. Interviews were transcribed and transcripts were analyzed thematically using NVIVO 12. RESULTS Providers identified three major decisions that reproductive-aged women face when a BRCA mutation is discovered: [1] "Do I want children?"; [2] "Do I want to take the chance of passing on this the mutation?"; and [3] "Do I want to carry a child?" Inherent decision challenges that are faced by both providers and patients included difficult decision type, competing options, scientifically uncertain outcomes, and challenging decision timing. Modifiable decisional needs included: inadequate knowledge, unrealistic expectations, unclear values and inadequate support or resources. Identified clinical gaps included counselling time constraints, lack of reliable sources of background information for patients or providers and need for time-sensitive, geographically accessible, and centralized care. CONCLUSION Our study identified a need for a patient information resource that can be immediately provided to patients who carry a BRCA genetic mutation. Other suggestions for clinical practice include more time during consultation appointments, adequate follow-up, value-centric counseling, access to psychosocial support, and a specialized decisional coach.
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Affiliation(s)
- E. S. Dason
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,Mount Sinai Fertility, 7th Floor, 250 Dundas St. W, Toronto, ON M5T 2Z5 Canada
| | - L. Drost
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. M. Greenblatt
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - A. S. Scheer
- grid.415502.7Department of General Surgery, St. Michaels Hospital, Unity Health Network, Toronto, ON M5B 1W8 Canada
| | - J. Han
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - M. Sobel
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - L. Allen
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - M. Jacobson
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.417199.30000 0004 0474 0188Department of Obstetrics and Gynecology, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - T. Doshi
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. Wolff
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - E. McMahon
- grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.17063.330000 0001 2157 2938Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8 Canada
| | - C. A. Jones
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2 Canada ,grid.492573.e0000 0004 6477 6457Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
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Weiseth A, Plough A, Aggarwal R, Galvin G, Rucker A, Henrich N, Miller K, Subramanian L, Hawrusik R, Berry W, Gullo S, Spigel L, Dever K, Loveless D, Graham K, Paek B, Shah NT. Improving communication and teamwork during labor: A feasibility, acceptability, and safety study. Birth 2022; 49:637-647. [PMID: 35233810 PMCID: PMC9790687 DOI: 10.1111/birt.12630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/15/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND TeamBirth was designed to promote best practices in shared decision making (SDM) among care teams for people giving birth. Although leading health organizations recommend SDM to address gaps in quality of care, these recommendations are not consistently implemented in labor and delivery. METHODS We conducted a mixed-methods trial of TeamBirth among eligible laboring patients and all clinicians (nurses, midwives, and obstetricians) at four high-volume hospitals during April 2018 to September 2019. We used patient and clinician surveys, abstracted clinical data, and administrative claims to evaluate the feasibility, acceptability, and safety of TeamBirth. RESULTS A total of 2,669 patients (approximately 28% of eligible delivery volume) and 375 clinicians (78% response rate) responded to surveys on their experiences with TeamBirth. Among patients surveyed, 89% reported experiencing at least one structured full care team conversation ("huddle") during labor and 77% reported experiencing multiple huddles. There was a significant relationship between the number of reported huddles and patient acceptability (P < 0.001), suggestive of a dose response. Among clinicians surveyed, 90% would recommend TeamBirth for use in other labor and delivery units. There were no significant changes in maternal and newborn safety measures. CONCLUSIONS Implementing a care process that aims to improve communication and teamwork during labor with high fidelity is feasible. The process is acceptable to patients and clinicians and shows no negative effects on patient safety. Future work should evaluate the effectiveness of TeamBirth in improving care experience and health outcomes.
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Affiliation(s)
- Amber Weiseth
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Avery Plough
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Reena Aggarwal
- Obstetrics and GynaecologyUniversity College London HospitalLondonUK
| | - Grace Galvin
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Amber Rucker
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Natalie Henrich
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Kate Miller
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Laura Subramanian
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Rebecca Hawrusik
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - William Berry
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Susan Gullo
- Ariadne LabsBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Lauren Spigel
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Kimberly Dever
- Department of Obstetrics and GynecologySouth Shore HospitalWeymouthMassachusettsUSA
| | | | - Kristin Graham
- Obstetrics and GynecologyOverlake Medical Center & ClinicsBellevueWashingtonUSA
| | - Bettina Paek
- Department of Women’s & Children’sEvergreenHealthKirklandWashingtonUSA
| | - Neel T. Shah
- Ariadne LabsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA,Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
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Duane M, Martinez V, Berry M, Manhart MD. Evaluation of a fertility awareness-based shared decision-making tool part 1: Study design and impact on clinician knowledge. PEC INNOVATION 2022; 1:100061. [PMID: 37213746 PMCID: PMC10194193 DOI: 10.1016/j.pecinn.2022.100061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 05/23/2023]
Abstract
Objective To assess the impact of a Shared Decision-Making (SDM) tool for fertility awareness-based methods (FABMs) of family planning. Methods Clinicians familiar with at least one FABM were randomly invited to participate in a prospective cross-over study to compare usual practice to the use of the SDM tool when discussing FABMs with patients. Patients completed surveys pre- and post-office visit and six months later. The primary outcome explored the effect of online education on use of the SDM tool on clinicians' knowledge of FABMs. Results Of 278 clinicians contacted, 54% could not be reached, and 15% did not provide women's health services. The 26 clinicians enrolled were experienced, with more than half recommending FABMs for ≥10 years, and 73% recommending more than one FABM to patients. Knowledge scores significantly improved after online training and use of the SDM tool (baseline mean score = 9.54 (scale of 0-12); post-training mean score = 10.73, p < 0.002). Conclusions Education about FABMs and training on use of the SDM tool improved knowledge scores even among an experienced cohort of clinicians. Innovation The novel SDM tool can better equip clinicians to meet the rising patient interest in FABMs.
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Affiliation(s)
- Marguerite Duane
- FACTS, 1020 Kearny St NE, Washington DC 20017, USA
- Corresponding author.
| | | | - Meghan Berry
- FACTS, 1020 Kearny St NE, Washington DC 20017, USA
| | - Michael D. Manhart
- FACTS, 1020 Kearny St NE, Washington DC 20017, USA
- Couple to Couple League International, 5440 Moeller Avenue Suite 149, Cincinnati, OH 45212, USA
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Goueth RC, Maki KG, Babatunde A, Eden KB, Darney BG. Effects of technology-based contraceptive decision aids: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:705-713.e9. [PMID: 35779590 PMCID: PMC9800645 DOI: 10.1016/j.ajog.2022.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/22/2022] [Accepted: 06/16/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and meta-analysis of the effects of technology-based decision aids on contraceptive use, continuation, and patient-reported and decision-making outcomes. DATA SOURCES A systematic search was conducted in OVID MEDLINE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, Embase, PsycINFO, and SocINDEX databases from January 2005 to April 2022. Eligible references from a concurrent systematic review evaluating contraceptive care were also included for review. STUDY ELIGIBILITY CRITERIA Studies were included if a contraceptive decision aid was technology-based (ie, mobile/tablet application, web, or computer-based) and assessed contraceptive use and/or continuation or patient-reported outcomes (knowledge, self-efficacy, feasibility/acceptability/usability, decisional conflict). The protocol was registered under the International Prospective Register of Systematic Reviews (CRD42021240755). METHODS Three reviewers independently performed data abstraction and quality appraisal. Dichotomous outcomes (use and continuation) were evaluated with an odds ratio, whereas continuous outcomes (knowledge and self-efficacy) were evaluated with the mean difference. Subgroup analyses were performed for the mode of delivery (mobile and tablet applications vs web and computer-based) and follow-up time (immediate vs >1 month). RESULTS This review included 18 studies evaluating 21 decision aids. Overall, there were higher odds of contraceptive use and/or continuation among decision aid users compared with controls (odds ratio, 1.27; 95% confidence interval, [1.05-1.55]). Use of computer and web-based decision aids was associated with higher odds of contraceptive use and/or continuation (odds ratio, 1.36; 95% confidence interval, [1.08-1.72]) than mobile and tablet decision aids (odds ratio, 1.27; 95% confidence interval, [0.83-1.94]). Decision aid users also had statistically significant higher self-efficacy scores (mean difference, 0.09; 95% confidence interval, [0.05-0.13]), and knowledge scores (mean difference, 0.04; 95% confidence interval, [0.01-0.07]), with immediate measurement of knowledge having higher retention than measurement after 1 month. Other outcomes were evaluated descriptively (eg, feasibility, applicability, decisional conflict) but had little evidence to support a definite conclusion. Overall, the review provided moderate-level evidence for contraceptive use and continuation, knowledge, and self-efficacy. CONCLUSION The use of technology-based contraceptive decision aids to support contraceptive decision-making has positive effects on contraceptive use and continuation, knowledge, and self-efficacy. There was insufficient evidence to support a conclusion about effects on other decision-making outcomes.
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Affiliation(s)
- Rose C Goueth
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
| | - Kristin G Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ayo Babatunde
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR; Pacific Northwest Evidence-based Practice Center, Portland, OR
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University -Portland State University, Portland, OR; Instituto Nacional de Salud Publica, Center for Population Health Research, Cuernavaca, Mexico
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Yam EA, Namukonda E, McClair T, Souidi S, Chelwa N, Muntalima N, Mbizvo M, Bellows B. Developing and Testing a Chatbot to Integrate HIV Education Into Family Planning Clinic Waiting Areas in Lusaka, Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100721. [PMID: 36316140 PMCID: PMC9622293 DOI: 10.9745/ghsp-d-21-00721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To maximize protection against both unintended pregnancy and HIV, it is important that family planning (FP) services integrate HIV counseling, both to support method choice and identify potential HIV services of interest, such as pre-exposure prophylaxis (PrEP). However, FP providers often lack sufficient time and knowledge to address HIV vulnerability with clients. To potentially offload some of the initial HIV counseling burden from FP providers, we developed and tested a chatbot that provided information about HIV and dual protection to FP clients in waiting areas of FP clinics in Lusaka, Zambia. CHATBOT DEVELOPMENT We drafted a scripted conversation and tested it in English in formative workshops with Zambian women between the ages of 15 and 49 years. After translating the content to Bemba and Nyanja, we conducted a second round of workshops to validate the translations, before uploading the content into the chatbot platform. CHATBOT USER TEST Thirty volunteers tested the chatbot in 3 Lusaka FP clinics, completing an exit survey to provide feedback. A large majority (83%) said they learned new HIV information from the chatbot. Twenty (67%) learned about PrEP for the first time through the chat. Most (96%) reported discussing HIV with the provider, after engaging with the chatbot. In response to an open-ended question, several testers volunteered that they wanted to learn more about PrEP. CONCLUSIONS Pre-consultation waiting-area time is an underutilized opportunity to impart HIV information to FP clients, thereby preparing them to discuss their dual HIV and pregnancy prevention needs when they see their providers. FP clients expressed particular interest in learning more about PrEP, underscoring the importance of integrating HIV into FP services.
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Affiliation(s)
| | | | | | - Samir Souidi
- International Rescue Committee, New York, NY, USA
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Implementation of a novel shared decision-making intervention in women with chronic hypertension in pregnancy: multiple-site multiple-method investigation. Pregnancy Hypertens 2022; 30:137-144. [PMID: 36194966 DOI: 10.1016/j.preghy.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication. OBJECTIVES Codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension. SETTING AND PARTICIPANTS Pregnant women with chronic hypertension and their principal healthcare professionals (obstetricians, midwives, and physicians), at three National Health Service hospital trusts with different models of care. MAIN OUTCOME MEASURES The RE-AIM framework guided the evaluation. Primary: Decisional conflict scale, medication intention survey and women's acceptability. Secondary: Healthcare professionals' acceptability and the barriers and facilitators to SDM implementation with pregnant women with chronic hypertension. RESULTS Fifty women participated. Nearly half (46 %; n = 23) of women were from Black and Asian backgrounds. The SDM intervention was effective at reducing decisional conflict (mean reduction from baseline 42 %, 95 % CI 35-49, p ≤ 0.05). In 36 women (72 %), the reduction was of clinical importance. 24 women (48 %) were uncertain about or planned not to take antihypertensives prior to the SDM intervention, compared to two women (4 %) after the intervention. The intervention was acceptable to women and healthcare professionals. 10 of 14 healthcare professionals felt that the in-consultation aid facilitated SDM in current antenatal contexts, a similar proportion (10/14) felt the length of consultations hindered SDM. CONCLUSION A novel codesigned SDM intervention reduced decisional conflict and increased women's intention to take antihypertensive agents during pregnancy. This intervention could be adopted into practice for women making pregnancy decisions where there is uncertainty around the medication management option.
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Spigel L, Plough A, Paterson V, West R, Jurczak A, Henrich N, Gullo S, Corrigan B, Patterson P, Short T, Early L, Bridges M, Pesek E, Pizzitola M, Davis D, Kirby K, Borduz C, Shah N, Weiseth A. Implementation strategies within a complex environment: A qualitative study of a shared decision-making intervention during childbirth. Birth 2022; 49:440-454. [PMID: 34997610 PMCID: PMC9543488 DOI: 10.1111/birt.12611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Shared decision-making (SDM) may improve communication, teamwork, patient experience, respectful maternity care, and safety during childbirth. Despite these benefits, SDM is not widely implemented, and strategies for implementing SDM interventions are not well described. We assessed the acceptability and feasibility of TeamBirth, an SDM solution that centers the birthing person in decision-making through simple tools that structure communication among the care team. We identified and described implementation strategies that bridge the gap between knowledge and practice. METHODS We conducted a qualitative study among four hospitals in the United States to understand the acceptability and feasibility of TeamBirth. We interviewed 103 clinicians and conducted 16 focus group discussions with 52 implementers between June 2018 and October 2019. We drew on the Consolidated Framework for Implementation Research to understand acceptability and feasibility, and to identify and describe the underlying contextual factors that affected implementation. RESULTS We found that clinicians and implementers valued TeamBirth for promoting clarity about care plans among the direct care team and for centering the birthing person in decision-making. Contextual factors that affected implementation included strength of leadership, physician practice models, and quality improvement culture. Effective implementation strategies included regular data feedback and adapting "flexible" components of TeamBirth to the local context. DISCUSSION By identifying and describing TeamBirth's contextual factors and implementation strategies, our findings can help bridge the implementation gap of SDM interventions. Our in-depth analysis offers tangible lessons for other labor and delivery unit leaders as they seek to integrate SDM practices in their own settings.
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Affiliation(s)
- Lauren Spigel
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA
| | - Avery Plough
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA
| | | | - Rebecca West
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA
| | - Amanda Jurczak
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA
| | - Natalie Henrich
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA
| | - Susan Gullo
- Ariadne LabsBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Brett Corrigan
- Quality Management DepartmentSouth Shore HospitalSouth WeymouthMassachusettsUSA,Maternity CenterSouth Shore HospitalSouth WeymouthMassachusettsUSA
| | - Pam Patterson
- Quality Management DepartmentSouth Shore HospitalSouth WeymouthMassachusettsUSA,Maternity CenterSouth Shore HospitalSouth WeymouthMassachusettsUSA
| | - Trisha Short
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA,Labor and DeliverySaint Francis HospitalTulsaOklahomaUSA
| | - Lisa Early
- Labor and DeliverySaint Francis HospitalTulsaOklahomaUSA
| | - Margie Bridges
- Women and Infant ServicesOverlake Medical Center & ClinicsBellevueWashingtonUSA
| | - Elizabeth Pesek
- Quality DepartmentOverlake Medical Center & ClinicsBellevueWashingtonUSA
| | - Marianne Pizzitola
- Women and Infant ServicesOverlake Medical Center & ClinicsBellevueWashingtonUSA
| | - Dianna Davis
- Operational ExcellenceEvergreenHealth Medical CenterKirklandWashingtonUSA
| | - Keri Kirby
- Quality DepartmentEvergreenHealth Medical CenterKirklandWashingtonUSA
| | - Christina Borduz
- Family Maternity CenterEvergreenHealth Medical CenterKirklandWashingtonUSA
| | - Neel Shah
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA
| | - Amber Weiseth
- Ariadne LabsHarvard School of Public HealthBostonMassachusettsUSA
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Jolles DR, Montgomery TM, Blankstein Breman R, George E, Craddock J, Sanders S, Niemcyzk N, Stapleton S, Bauer K, Wright J. Place of Birth Preferences and Relationship to Maternal and Newborn Outcomes Within the American Association of Birth Centers Perinatal Data Registry, 2007-2020. J Perinat Neonatal Nurs 2022; 36:150-160. [PMID: 35476769 DOI: 10.1097/jpn.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. METHODS Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. RESULTS While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. CONCLUSION This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation.
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Affiliation(s)
- Diana R Jolles
- Frontier University, Tucson, Arizona (Dr Jolles); American Association of Birth Centers Research Committee, Perkiomenville, Pennsylvania (Drs Jolles, Niemcyzk, and Stapleton and Mss Sanders, Bauer, and Wright); Department of Nursing, Temple University College of Public Health, Philadelphia, Pennsylvania (Dr Montgomery); University of Maryland School of Nursing, Baltimore (Dr Blankstein Breman); Boston College Connell School of Nursing, Boston, Massachusetts (Ms George); University of Maryland College of Social Work, Baltimore (Dr Craddock); and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sanders and Dr Niemcyzk)
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Educational Multimedia Tool Compared With Routine Care for the Uptake of Postpartum Long-Acting Reversible Contraception in Individuals With High-Risk Pregnancies: A Randomized Controlled Trial. Obstet Gynecol 2022; 139:571-578. [PMID: 35594122 DOI: 10.1097/aog.0000000000004718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether an intervention with a multimedia educational tool, compared with routine care, would increase the use of long-acting reversible contraceptives (LARC) at 12 weeks postpartum in individuals with high-risk pregnancies. METHODS In this single-center randomized trial, we assigned individuals aged 13-50 years with high-risk pregnancies to either a multimedia educational tool or routine care. Participants were included during pregnancy through postpartum day 1. Those randomized to the multimedia educational tool (MET) group were provided a tablet with the preloaded 3-5-minute multimedia presentation (https://prezi.com/view/jpFrXaPnnxuqRkcI3A4a/), which was viewed without the presence of research staff and resent by secure email every 4 weeks if undelivered. The primary outcome was uptake of LARC (implant or intrauterine device) within 12 weeks of delivery. The secondary outcomes included overall use of any method of contraception and composite maternal and neonatal adverse outcomes. A priori estimates indicated that 380 participants were needed to detect a 40% difference in use of LARC (baseline 40%; alpha=0.05, power=0.8, assumed loss to follow-up 20%). Relative risk (RR) and number needed to treat (NNT), along with 95% CIs, were calculated. RESULTS From July 2020 through December 2020, 536 persons were screened and 380 randomized as follows: 190 for the multimedia educational tool and 190 for routine care. Demographic characteristics were similar between groups. The primary outcome-available for more than 90% of participants-was higher in the MET group (32.4%) than in the routine care (RC) group (20.9%) (RR 1.55; 95% CI 1.09-2.21; NNT nine, with 95% CI 5-42). Overall use of contraception was also higher in the MET group than in the RC group (RR 1.16; 95% CI 1.03-1.32). CONCLUSION Among individuals with high-risk pregnancies, compared with routine care, use of a multimedia-based educational tool increased the uptake of postpartum LARC by 55%. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04291040. FUNDING SOURCE Funded in part by Investigator-Initiated studies of Organon.
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Dawson A, Assifi A, Turkmani S. Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines. Reprod Health 2022; 19:50. [PMID: 35193606 PMCID: PMC8862274 DOI: 10.1186/s12978-022-01356-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. METHOD We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. FINDINGS One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. CONCLUSION This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care.
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Affiliation(s)
- Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia.
| | - Anisa Assifi
- Department of General Practice, Monash University, Melbourne, Australia
| | - Sabera Turkmani
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia
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Whybrow R, Webster LM, Seed PT, Sandall J, Chappell LC. The effectiveness of decision aids for pregnancy related decision-making in women with pre-pregnancy morbidity; systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:81. [PMID: 35093017 PMCID: PMC8801107 DOI: 10.1186/s12884-022-04402-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/11/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Women with pre-existing morbidity arising from medical conditions or previous caesarean section are at higher risk of adverse pregnancy outcomes compared to women without such morbidity. Women often face complex pregnancy-related decision-making that may be characterized by conflicting maternal and perinatal priorities. The aim of this systematic review and meta-analysis was to assess randomised controlled trials of decision aids to evaluate whether they are effective at reducing decisional conflict scores and to evaluate what type of decision aids are most effective for women with pre-existing morbidity in pregnancy. METHODS We searched Medline (via Ovid), Embase (via Ovid), CINAHL (via EBSCO) from the earliest entries until September 2021. We selected randomised controlled trials comparing patient decision aids for women with pre-existing morbidity with usual clinical practice or a control intervention. Study characteristics and Jadad risk of bias was recorded. Meta-analysis by pre-existing morbidity type was performed using Stata 17 and the data was presented with a Forest Plot. Random effects models were used to calculate summary estimates if there was substantial clinical or statistical heterogeneity and post mean DCS scores were described in a sensitivity analysis and presented as a line graph, to improve clinical interpretation of results.. A narrative synthesis of the selected studies evaluated what type of decision aid works and for in what circumstances. RESULTS Ten randomised controlled trials, which reported data from 4028 women, were included. Patient decision aids were evaluated in women with pre-existing morbidity who were undertaking pregnancy-related decision-making. Patient decision aids reduced decisional conflict scale scores by an additional - 3.7, 95% Confidence Interval - 5.9% to - 1.6%) compared to the control group. Women with pre-existing medical conditions were more conflicted at baseline and had greater reductions in decisional conflict scale score (mean difference vs. control group: - 6.6%; 95% CI - 9.8% to - 3.3%), in contrast to those with previous caesarean section (mean difference - 2.4%; 95% CI - 4.8% to - 0.1%). There was limited evidence on the effect of decision aids on health outcomes. Decision aids reduced unwanted variation in decision-making support across maternity settings. CONCLUSION Patient decision aids are effective tools to support personalised care planning and informed decision-making in women with pre-existing morbidity. Women with pre-existing medical morbidity were more conflicted at baseline and were more likely to benefit from decision aids. Adoption of aids in this population may lead to improve adherence and health outcomes, warranting further research.
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Affiliation(s)
- Rebecca Whybrow
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK.
| | - Louise M Webster
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
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Marques F, Josloff K, Hung K, Wakamatsu M, Sepucha KR. Decision aids and shared decision making in urogynecology. Menopause 2021; 29:178-183. [PMID: 34905749 DOI: 10.1097/gme.0000000000001901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the efficacy and acceptability of decision aids (DAs) in counseling urogynecology patients with prolapse, stress urinary incontinence, or refractory overactive bladder. METHODS This pilot study enrolled 33 patients into a control group that underwent usual care without a DA, followed by 33 patients into an intervention group where providers utilized a DA for counseling. Postvisit patient surveys assessed differences in treatment preference, knowledge, and in patient-physician collaboration using SURE, CollaboRATE, and Shared Decision Making (SDM) Process scales. Postvisit provider surveys assessed their perception of the usefulness and the difficulty of using a DA and visit length. Independent t tests were used for continuous variables (Knowledge and SDM Process scores) and Chi-Square for categorical variables (treatment preference, SURE, and CollaboRATE). RESULTS The majority of eligible patients 66/71 (93%) completed the survey. The intervention group trended toward higher knowledge scores (72% vs 60%, P = 0.06), clearer treatment preferences (85% vs 67%, P = 0.08), higher rates of top SURE scale scores (91% vs 73%, P = 0.11), and top CollaboRATE scores (75% vs 52%, P = 0.07). SDM process scores were similar across groups (3.2 vs 3.2, P = 0.96). Providers used the DA in 73% of intervention group visits and rated the visit length as "normal" in both groups (70% vs 76%, P = 0.78). CONCLUSIONS There were no statistically significant differences between the control group and the intervention group. The use of DAs was acceptable to providers and indicated a trend toward increased patient knowledge, treatment preference, and satisfaction. A larger study is warranted to examine the impact of DAs on decision making and patient experience.
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Affiliation(s)
- Felisha Marques
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kevan Josloff
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kristin Hung
- Vincent Obstetrics and Gynecology Department, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA
| | - May Wakamatsu
- Vincent Obstetrics and Gynecology Department, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA
| | - Karen R Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Knippler ET, Mwamba RN, Coleman JN, Knettel BA, Minja LM, Kisigo GA, Ngocho JS, Cichowitz C, Mmbaga BT, Watt MH. Attitudes Toward Pregnancy Among Women Enrolled in Prevention of Mother-to-Child Transmission of HIV (PMTCT) Services in Moshi, Tanzania. AIDS Behav 2021; 25:4008-4017. [PMID: 34125322 DOI: 10.1007/s10461-021-03339-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
For pregnant women living with HIV (WLWH), feelings about pregnancy may influence their emotional well-being and health seeking behaviors. This study examined attitudes toward pregnancy and associated factors among women enrolled in prevention of mother-to-child transmission of HIV (PMTCT) services in Moshi, Tanzania. 200 pregnant WLWH were enrolled during their second or third trimester of pregnancy and completed a structured survey. Univariable and multivariable regression models examined factors associated with attitudes toward pregnancy, including demographics, interpersonal factors, and emotional well-being. Attitudes toward the current pregnancy were generally positive, with 87% of participants reporting feeling happy about being pregnant. In the final multivariable model, having higher levels of partner support, being newly diagnosed with HIV, and having fewer children were significantly associated with more positive attitudes toward their pregnancy. Findings point to a need for tailored psychosocial support services in PMTCT, as well as comprehensive reproductive health care for WLWH.
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Affiliation(s)
- Elizabeth T Knippler
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
- UNC Gillings School of Global Public Health, 104 Rosenau Hall 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jessica N Coleman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Godfrey A Kisigo
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Cody Cichowitz
- Department of Medicine, Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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McKinney JL, Keyser LE, Pulliam SJ, Ferzandi TR. Female Urinary Incontinence Evidence-Based Treatment Pathway: An Infographic for Shared Decision-Making. J Womens Health (Larchmt) 2021; 31:341-346. [PMID: 34747662 PMCID: PMC8972010 DOI: 10.1089/jwh.2021.0266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives: Urinary incontinence (UI) is a highly prevalent burdensome condition among adult females in the United States, yet rates of care-seeking, evaluation, and treatment are nonoptimal. Components of evaluation and treatment are informed by research and professional society guidelines; however, a visual representation of this guidance does not exist. The objectives of this study are to review the literature regarding female UI care and to synthesize this information into a graphical format to facilitate health education, health care delivery, and shared decision-making. Methods: We reviewed published society guidelines, position statements, and associated references from the American College of Obstetrics and Gynecology, the Women's Preventive Services Initiative, American Academy of Family Physicians, American College of Physicians, the Society of Urodynamics and Female Urology, the American Urological Association, and the American Urogynecologic Society, and searched PubMed for related literature. We synthesized these findings into an evidence-based infographic depicting female UI risk factors, influences on care-seeking and provision, screening, evaluation, and a stepwise treatment approach. Results: This study summarizes current evidence and professional guidelines related to female UI into a compelling visual format and accompanying narrative. The infographic is intended as a tool for patient education, clinical practice, and research to facilitate shared decision-making and health care delivery. Conclusions: Female UI is highly prevalent, yet diagnosis and treatment are suboptimal. Use of an evidence-based infographic may positively impact patient knowledge and certainty about UI treatment and support health care provider counseling and decision-making.
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Affiliation(s)
- Jessica L McKinney
- School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia, Inc., Boston, Massachusetts, USA
| | - Laura E Keyser
- School of Rehabilitation Sciences, Andrews University, Berrien Springs, Michigan, USA.,Renovia, Inc., Boston, Massachusetts, USA
| | - Samantha J Pulliam
- Renovia, Inc., Boston, Massachusetts, USA.,Tufts Medical Center, Boston, Massachusetts, USA
| | - Tanaz R Ferzandi
- Urogynecology and Pelvic Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
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Matsushita T, Hasegawa T, Noma H, Ota E, Chou VB, Okada Y. Interventions to increase access to long-acting reversible contraceptives. Hippokratia 2021. [DOI: 10.1002/14651858.cd014987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomomi Matsushita
- Department of Obstetrics and Gynaecology; Showa University School of Medicine; Tokyo Japan
| | - Takeshi Hasegawa
- Showa University Research Administration Center (SURAC); Showa University; Tokyo Japan
| | - Hisashi Noma
- Department of Data Science; The Institute of Statistical Mathematics; Tokyo Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science; St. Luke's International University; Chuo-ku Japan
| | - Victoria B Chou
- Department of International Health; Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland USA
| | - Yoshiyuki Okada
- Department of Obstetrics and Gynecology; Showa University Northern Yokohama Hospital; Kanagawa Japan
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Brault MA, Curry LA, Kershaw TS, Singh K, Vash-Margita A, Camenga DR. Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health-Perspectives to Build an Appointment Planning Tool. J Pediatr Adolesc Gynecol 2021; 34:725-731. [PMID: 33989800 PMCID: PMC10712738 DOI: 10.1016/j.jpag.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE Input from adolescents and healthcare providers is needed to develop electronic tools that can support patient-centered sexual and reproductive (SRH) care. This study explores facilitators and barriers to patient-centered communication in the context of developing an electronic appointment planning tool to promote SRH communication in clinic settings. DESIGN In-depth interviews were conducted to explore what constitutes adolescent-friendly SRH care and communication, as well as on the design of the appointment planning tool. Interviews were coded iteratively, and analyzed using the software Atlas.TI v8. SETTING An adolescent primary care clinic, and a pediatric and adolescent gynecology clinic. PARTICIPANTS Adolescent girls (N=32; ages 14-18) and providers who care for adolescent girls (N=10). MAIN OUTCOME MEASURES Thematic analyses explored facilitators/barriers to SRH communication and care and preferences for the tool. RESULTS Facilitators identified by adolescents and providers included: direct patient/provider communication; adolescent-driven decision-making regarding care and contraceptive choice; supplementing clinic visits with electronic resources; and holistic care addressing physical, mental, and social needs. Barriers identified by participants included: limited time for appointments; limited adolescent autonomy in appointments; and poor continuity of care when adolescents cannot see the same provider. Given the complexity of issues raised, adolescents and providers were interested in developing an appointment planning tool to guide communication during appointments, and contributed input on its design. The resulting Appointment Planning Tool app pilot is in progress. CONCLUSIONS Qualitative interviews with adolescents and providers offer critical insights for the development and implementation of mobile health (mHealth) tools that can foster patient-centered care.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA.
| | - Leslie A Curry
- Global Health Leadership Initiative, 100 Church Street South, Yale School of Public Health, New Haven, CT, 06519, USA; Department of Health Policy and Management, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Karen Singh
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Farnham Memorial Building, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Deepa R Camenga
- Department of Emergency Medicine, 464 Congress Avenue, Suite 260, Yale School of Medicine, New Haven, CT, 06519, USA
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Venkatesh KK, Brodney S, Barry MJ, Jackson J, Lyons KM, Talati AN, Ivester TS, Munoz MC, Thorp JM, Nicholson WK. Patient decision aid for trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery: a quasi-experimental pre-post study. BMC Pregnancy Childbirth 2021; 21:650. [PMID: 34556061 PMCID: PMC8461956 DOI: 10.1186/s12884-021-04119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/29/2021] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To assess the impact of a web-based decision aid on patient-centered decision making outcomes among women considering a trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery. METHODS The Birth Decision Aid Study (B-READY) was a quasi-experimental pre-post study of two sequential cohorts. From June 18, 2018 to July 31, 2019, 50 women were enrolled in routine care, followed by 50 women who were enrolled in the decision aid group. Inclusion criteria were singleton pregnancies between 19/0 to 36/6 weeks, ≤2 prior cesareans, and no contraindications to TOLAC. The decision aid group viewed the online Healthwise® "Pregnancy: Birth Options After Cesarean" program. Both groups received the same birth options counseling and completed the same online assessment. Primary patient-centered outcomes were knowledge about birth options and shared decision making at online assessment, and informed, patient-centered decision making about her preferred mode of delivery at delivery admission. RESULTS Among 100 women participated in this study (50 per group), the mean gestational age at enrollment was 31 weeks, and 71% or 63/89 women who consented to delivery data abstraction had a cesarean delivery. Women in the patient decision aid group gained more knowledge (defined as score ≥ 75%) about birth options compared to those in the routine care group (72% vs. 32%; adjusted odds ratio, AOR: 6.15 [95% CI: 2.34 to 16.14]), and were more likely to make an informed, patient-centered decision (60% vs. 26%; AOR: 3.30 [95% CI: 1.20 to 9.04]. Women in both groups reported similar involvement in shared decision making, as well as satisfaction and values. More than 90% of decision aid users reported it was a useful tool and would recommend it to other TOLAC-eligible women. CONCLUSIONS A web-based birth options patient-centered decision aid for TOLAC eligible women can be integrated into prenatal Telehealth and may improve the quality of decision making about mode of delivery. TRIAL REGISTRATION The study was registered with ClinincalTrials.gov and the ID# was NCT04053413 . Registered 12 August 2019 - Retrospectively registered.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, 395 W. 12th Ave., Floor 5, Columbus, OH, USA.
| | - Suzanne Brodney
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jamie Jackson
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Kiira M Lyons
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Asha N Talati
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Thomas S Ivester
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Maria C Munoz
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - John M Thorp
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Wanda K Nicholson
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Carauleanu A, Tanasa IA, Nemescu D, Socolov D. Risk management of vaginal birth after cesarean section (Review). Exp Ther Med 2021; 22:1111. [PMID: 34504565 PMCID: PMC8383756 DOI: 10.3892/etm.2021.10545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 11/05/2022] Open
Abstract
The increasing number of patients who desire to experience vaginal birth after cesarean (VBAC) and the optimized protocols for trial of labor after cesarean (TOLAC) has led to a shift of old obstetrical paradigms. The VBAC trend is accompanied with numerous challenges for healthcare professionals, from establishing suitability of each pregnant patient profile for TOLAC to active labor management, and ethical or legal issues, which occasionally are not included in specific guidelines. That is why an individualized risk assessment and management can serve obstetricians as a useful tool for improving outcomes of patients, satisfaction, and also for avoiding legal or moral liabilities. The risk management concept aims to reduce foreseen risks and to emulate strategies for prediction and prevention of unwanted events. In obstetrics, and particularly for the VBAC topic, this concept is relatively new and undefined, and thus its features are disparate between guideline recommendations and clinical studies. This narrative review intends to offer a new and organic perspective over clinical aspects of TOLAC and VBAC risk management.
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Affiliation(s)
- Alexandru Carauleanu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ingrid Andrada Tanasa
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Dayaratna S, Sifri R, Jackson R, Powell R, Sherif K, DiCarlo M, Hegarty SE, Petrich A, Lambert E, Quinn A, Myers R. Preparing women experiencing symptoms of menopause for shared decision making about treatment. Menopause 2021; 28:1060-1066. [PMID: 34260477 DOI: 10.1097/gme.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a decision support intervention that can be used with women experiencing menopausal symptoms to facilitate treatment shared decision making. METHODS Our research team contacted patients with reported menopausal symptoms by telephone to obtain consent and administer a baseline survey. Subsequently, we sent participants a booklet on the treatment of menopausal symptoms. A nurse educator then contacted participants by telephone to review the booklet and guide them through a structured decision counseling exercise designed to help clarify treatment preference. A 60-day endpoint telephone survey was completed. RESULTS Forty-eight consenting participants completed the baseline survey and 37 (77%) also completed a decision counseling session. At baseline, 19 of the women who had decision counseling were not being treated for menopausal symptoms and 18 were being treated. After decision counseling, 13 (68%) participants who were not being treated and 14 (78%) who were being treated identified a preferred treatment. Comparison of baseline and endpoint survey data showed that participant treatment knowledge increased (P = 0.007) and treatment decisional conflict decreased (P < 0.001). Furthermore, 71% of participants reported that they had received new information about treatment and 94% said they believed better prepared to discuss treatment with their healthcare provider. CONCLUSIONS Nurse-led decision counseling increased participant treatment knowledge, reduced treatment decisional conflict, and helped to clarify treatment preference. Implementation of this strategy could help to facilitate provider-patient shared decision making about the treatment of menopausal symptoms.
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Affiliation(s)
- Sandra Dayaratna
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
| | - Randa Sifri
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca Jackson
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
| | - Rhea Powell
- Division of Internal Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Katherine Sherif
- Division of Women's Health, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Sarah E Hegarty
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Anett Petrich
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Emily Lambert
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Anna Quinn
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Ronald Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
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Zizzo G, Amir LH, Moore V, Grzeskowiak LE, Rumbold AR. The risk-risk trade-offs: Understanding factors that influence women's decision to use substances to boost breast milk supply. PLoS One 2021; 16:e0249599. [PMID: 33939738 PMCID: PMC8092651 DOI: 10.1371/journal.pone.0249599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/20/2021] [Indexed: 12/21/2022] Open
Abstract
Galactagogues are foods, herbs or medications thought to support or increase breast milk supply. The use of galactagogues during lactation is becoming increasingly common despite limited evidence regarding effectiveness and safety, and no definitive recommendations for use in clinical practice. The aim of this study is to explore factors influencing women's decisions to use galactagogues during lactation. Twenty-two semi-structured interviews were conducted in October and November 2019 (over the telephone or in person) with participants located in most Australian states and territories, including metro and regional areas. Interviews were audio-recorded, transcribed verbatim and thematically analysed using NVivo. Analysis revealed that following a concern about breast milk supply, the decision to use galactagogues was influenced by three core and interrelated domains: access to and quality of breastfeeding support, maternal agency and determination to provide breast milk. Women revealed many problematic experiences with health care professionals that left them feeling dismissed and confused due to provision of inconsistent and insufficient information that was sometimes at odds with their desire to provide breast milk. In this instance, some women turned to galactagogues to regain agency. A range of broader dimensions influencing decision-making also emerged. These were separated into categories that emphasise distinctions relating to breast milk supply, which included: maternal emotional wellbeing, social norms and pressures, concerns about infant development, maternal physical health and lactation history, as well as those relating specifically to galactagogue use, including: desire for a guaranteed/urgent response, risk-risk trade-off, acceptance and trust, and accessibility and cost. In understanding the complexity of decision-making concerning these substances, we identify opportunities to improve breastfeeding counselling and support. We recommend that support be individually tailored to manage conflicting information, adopt communication styles that encourage trust and processes that enable shared decision-making to enhance or restore maternal agency. There is also considerable need to address evidence gaps regarding the effectiveness and safety of commonly used galactagogues, so that women can be appropriately counselled about potential benefits and harms.
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Affiliation(s)
- Gabriella Zizzo
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- * E-mail:
| | - Lisa H. Amir
- Judith Lumley Centre, La Trobe University | Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Vivienne Moore
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Luke E. Grzeskowiak
- Faculty of Health and Medical Sciences, The University of Adelaide, South Australia | Women and Kids, South Australian Health and Medical Research Institute, South Australia, Australia
| | - Alice R. Rumbold
- Women and Kids, South Australian Health and Medical Research Institute, South Australia, Australia
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Informed Consent and Shared Decision Making in Obstetrics and Gynecology: ACOG Committee Opinion, Number 819. Obstet Gynecol 2021; 137:e34-e41. [PMID: 33481530 DOI: 10.1097/aog.0000000000004247] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Meeting the ethical obligations of informed consent requires that an obstetrician-gynecologist gives the patient adequate, accurate, and understandable information and requires that the patient has the ability to understand and reason through this information and is free to ask questions and to make an intentional and voluntary choice, which may include refusal of care or treatment. Shared decision making is a patient-centered, individualized approach to the informed consent process that involves discussion of the benefits and risks of available treatment options in the context of a patient's values and priorities. Some informed consent challenges are universal to medicine, whereas other challenges arise more commonly in the practice of obstetrics and gynecology than in other specialty areas. This Committee Opinion focuses on informed consent for adult patients in clinical practice and provides new guidance on the practical application of informed consent through shared decision making. The principles outlined in this Committee Opinion will help support the obstetrician-gynecologist in the patient-centered informed consent process.
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Palmsten K, Bredesen D, JaKa MM, Kumar PC, Ziegenfuss JY, Kharbanda EO. "I know my body better than you:" patient focus groups to inform a decision aid on oral corticosteroid use during pregnancy. Pharmacoepidemiol Drug Saf 2021; 30:451-461. [PMID: 33314542 PMCID: PMC8686489 DOI: 10.1002/pds.5183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/07/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE There is unmet need for decision support regarding medication use during pregnancy. We aimed to inform the development of a decision aid on oral corticosteroid (OCS) use during pregnancy through focus groups. METHODS We invited patients from one health system who had a recent live birth and a condition for which OCSs may be prescribed (ie, asthma or other autoimmune disease) to participate in focus groups. We conducted conventional qualitative content analysis of verbatim transcripts of the focus groups using inductive coding. RESULTS There were 30 participants across five focus groups from May to June 2019. Women endorsed the need for patient-provider discussions about OCS use during pregnancy in which the provider shares risks and benefits and the patient makes her decision. Furthermore, women generally expressed support for patient-centered handouts about OCS use during pregnancy that the provider discusses with the patient. When considering whether to take OCSs in pregnancy, women had concerns about: the medication's impact on their baby (eg, miscarriage, birth defects, long-term effects), themselves (eg, effects on mood, sleep, weight gain), pregnancy complications (eg, preterm birth, increased blood pressure), and lactation. Women wanted information on OCSs (eg, indications, length of treatment, and cost), alternative treatments, and risks of not taking OCSs. CONCLUSIONS We established patient need for a decision aid on OCS use during pregnancy that providers can discuss with patients. To address patient concerns, the aid should at a minimum describe the medication's impact on baby, including long-term effects, maternal health, pregnancy complications, and lactation.
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Lee SY, Brodyn AL, Koppel RS, Tyler CP, Geppert AA, Truehart AI, Gilliam ML. Provider and Patient Perspectives on a New Tangible Decision Aid Tool to Support Patient-Centered Contraceptive Counseling with Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2021; 34:18-25. [PMID: 33096227 DOI: 10.1016/j.jpag.2020.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/17/2020] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE Despite the benefits of patient-centered contraceptive care, many adolescents and young adults do not receive such care. The objective of this study was to develop and evaluate Hello Options, a tangible decision aid to support patient-centered contraceptive counseling with adolescents and young adults in a clinic setting. DESIGN, SETTING, PARTICIPANTS, INTERVENTION, AND MAIN OUTCOME MEASURES: Hello Options is a contraceptive counseling decision aid tool (hereafter referred to as "the Tool") that allows patients to see and feel life-size "tangible" models of the range of contraceptive methods. The Tool was developed by a team of designers, adolescents, clinicians, and researchers using human-centered design. From December 2019 to March 2020, we conducted a pilot study to evaluate the usability, feasibility, and acceptability of the Tool with 10 contraceptive care providers and 40 adolescent and young adult patients (aged 12-29 years) at two Chicago clinics. We calculated descriptive statistics for patient survey data, and qualitatively analyzed provider interview transcripts for salient themes using recursive abstraction. RESULTS Patients had positive reactions to the Tool, reporting that it allowed them to better understand how contraceptive methods work in their body and that it allowed them to make more informed decisions. Furthermore, providers commented that the Tool facilitated conversations with their patients, helped dispel myths about particular methods, and eased patients' anxieties. Limitations mentioned included storage and portability concerns, and time constraints for counseling. CONCLUSION Hello Options is a useful, feasible, and acceptable decision aid that can support the provision of patient-centered contraceptive care for young people.
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Affiliation(s)
- Soo Young Lee
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL.
| | - Adriana L Brodyn
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Rebecca S Koppel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Crystal P Tyler
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Amanda A Geppert
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Amber I Truehart
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Melissa L Gilliam
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
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Duffy JMN, Cairns AE, Magee LA, von Dadelszen P, van 't Hooft J, Gale C, Brown M, Chappell LC, Grobman WA, Fitzpatrick R, Karumanchi SA, Lucas DN, Mol B, Stark M, Thangaratinam S, Wilson MJ, Williamson PR, Ziebland S, McManus RJ. Standardising definitions for the pre-eclampsia core outcome set: A consensus development study. Pregnancy Hypertens 2020; 21:208-217. [PMID: 32674052 DOI: 10.1016/j.preghy.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To develop consensus definitions for the core outcome set for pre-eclampsia. STUDY DESIGN Potential definitions for individual core outcomes were identified across four formal definition development initiatives, nine national and international guidelines, 12 Cochrane systematic reviews, and 79 randomised trials. Eighty-six definitions were entered into the consensus development meeting. Ten healthcare professionals and three researchers, including six participants who had experience of conducting research in low- and middle-income countries, participated in the consensus development process. The final core outcome set was approved by an international steering group. RESULTS Consensus definitions were developed for all core outcomes. When considering stroke, pulmonary oedema, acute kidney injury, raised liver enzymes, low platelets, birth weight, and neonatal seizures, consensus definitions were developed specifically for low- and middle-income countries because of the limited availability of diagnostic interventions including computerised tomography, chest x-ray, laboratory tests, equipment, and electroencephalogram monitoring. CONCLUSIONS Consensus on measurements for the pre-eclampsia core outcome set will help to ensure consistency across future randomised trials and systematic reviews. Such standardization should make research evidence more accessible and facilitate the translation of research into clinical practice. Video abstract can be available at: www.dropbox.com/s/ftrgvrfu0u9glqd/6.%20Standardising%20definitions%20in%20teh%20pre-eclampsia%20core%20outcome%20set%3A%20a%20consensus%20development%20study.mp4?dl=0.
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Affiliation(s)
- James M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; Institute for Women's Health, University College London, London, United Kingdom.
| | - Alexandra E Cairns
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynecology, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, United Kingdom
| | - Mark Brown
- Department of Renal Medicine, St George Hospital and University of New South Wales, Kogarah, Australia
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - William A Grobman
- Department of Obstetrics and Gynaecology, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - D Nuala Lucas
- London North West University Healthcare NHS Trust, Harrow, United Kingdom
| | - Ben Mol
- Women's Health Care Research Group, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Michael Stark
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Mathew J Wilson
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Farrell RM, Pierce M, Collart C, Edmonds BT, Chien E, Coleridge M, Rose SL, Perni U, Frankel R. Making the most of the first prenatal visit: The challenge of expanding prenatal genetic testing options and limited clinical encounter time. Prenat Diagn 2020; 40:1265-1271. [PMID: 32441820 PMCID: PMC10114520 DOI: 10.1002/pd.5752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Advances in prenatal genetics place additional challenges as patients must receive information about a growing array of screening and testing options. This raises concerns about how to achieve a shared decision-making process that prepares patients to make an informed decision about their choices about prenatal genetic screening and testing options, calling for a reconsideration of how healthcare providers approach the first prenatal visit. METHODS We conducted interviews with 40 pregnant women to identify components of decision-making regarding prenatal genetic screens and tests at this visit. Analysis was approached using grounded theory. RESULTS Participants brought distinct notions of risk to the visit, including skewed perceptions of baseline risk for a fetal genetic condition and the implications of screening and testing. Participants were very concerned about financial considerations associated with these options, ranking out-of-pocket costs on par with medical considerations. Participants noted diverging priorities at the first visit from those of their healthcare provider, leading to barriers to shared decision-making regarding screening and testing during this visit. CONCLUSION Research is needed to determine how to restructure the initiation of prenatal care in a way that best positions patients to make informed decisions about prenatal genetic screens and tests.
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Affiliation(s)
- Ruth M Farrell
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Madelyn Pierce
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christina Collart
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Edward Chien
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Susannah L Rose
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA.,Office of Patient Experience, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Uma Perni
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard Frankel
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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In Reply. Obstet Gynecol 2020; 135:1226-1227. [PMID: 32332396 DOI: 10.1097/aog.0000000000003848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Connect the Dots—February 2020. Obstet Gynecol 2020; 135:479-480. [DOI: 10.1097/aog.0000000000003681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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