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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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2
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Collins SA. Excluding Male Trainees in Obstetrics and Gynecology: Why We Do It and Why It's Wrong. Int Urogynecol J 2024; 35:31-34. [PMID: 38117297 DOI: 10.1007/s00192-023-05705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023]
Abstract
This article explores the current landscape of clinical education in obstetrics and gynecology for medical students, residents, and fellows who identify as male. Academic, clinical instruction should be inclusive for the betterment of the training experience for all, but most importantly, for the betterment of women's health.
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Affiliation(s)
- Sarah A Collins
- Department of Obstetrics and Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, The University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA.
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Nguyen H, Brown O, Bretschneider CE, Mueller M, Geynisman-Tan J, Lewicky-Gaupp C, Kenton K, Collins S. Use of a Computerized Decisional Analysis Tool in Patients With Urgency Urinary Incontinence. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:757-762. [PMID: 37607310 DOI: 10.1097/spv.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
IMPORTANCE Decision analysis tools (DAT) are shared decision making instruments that include patient input on treatment goals and values that have been shown to decrease decisional regret in women's health care. OBJECTIVE We describe a novel, computerized DAT for patients with urinary incontinence (UI), and our primary aim was to assess the concordance between treatment fit as determined by the DAT and treatment selected after physician counseling in patients with urgency urinary incontinence and urgency predominant mixed urinary incontinence. STUDY DESIGN We partnered with a health care startup to develop a computerized DAT incorporating evidence about UI and patient input about treatment goals and personal values. This is a retrospective cohort study examining the concordance of DAT-predicted treatments identified before consultation with the physician and those chosen after counseling. Electronic medical records were reviewed to abstract demographic, clinical data, and treatments chosen at the initial physician consultation. Because it was possible to pursue concurrent treatment options (ie, pelvic floor physical therapy and medications), the first 2 modalities identified in the treatment plan at consultation were abstracted. Descriptive statistics were conducted using SPSS®, we did not adjust for multiple comparisons. RESULTS Four hundred eighty-nine patients met the inclusion criteria for our study, and 65% of the cohort chose treatment options after counseling that were concordant with their DAT best treatment fit. CONCLUSION Patients choosing treatment for urgency urinary incontinence and urgency predominant mixed urinary incontinence using a novel, computer-based DAT to prepare for shared decision making with their physicians often choose to proceed with their top DAT-determined treatment fit after counseling.
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Affiliation(s)
- Hoa Nguyen
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
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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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Lu JYT, McKinn S, Freeman L, Turbitt E, Bonner C. Do online decision aids reflect new prenatal screening and testing options? An environmental scan and content analysis. PEC INNOVATION 2022; 1:100038. [PMID: 37213778 PMCID: PMC10194264 DOI: 10.1016/j.pecinn.2022.100038] [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: 12/08/2021] [Revised: 03/15/2022] [Accepted: 04/11/2022] [Indexed: 05/23/2023]
Abstract
Objective Decision aids have been developed to help prospective parents make informed, shared decisions about medical tests, but these options are rapidly changing. This study aimed to identify and evaluate publicly available decision aids written in English for prospective parents seeking prenatal test information. Methods A systematic review process was followed using 3 sources: known decision aid repositories, fetal medicine organisations and Google. The search, screening process, quality assessment, and data extraction was performed by two independent researchers. The quality assessment of the decision aids was based on the International Patient Decision Aids Standards (IPDAS v.4.0). Results We identified 13 decision aids, which varied in the screening and diagnostic tests that they discussed. No decision aid met all the IPDAS v.4.0. criteria and no decision aid reported updated risk of miscarriage for amniocentesis and chorionic villus sampling (CVS). There was a lack of decision aids for some common decisions in the prenatal context. Conclusion We identified outdated content in current prenatal decision aids. The findings will inform healthcare professionals of the quality of current prenatal decision aids, which may facilitate their patients' informed decision-making about prenatal tests. Innovation Considerations for improving future decision aids are outlined.
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Affiliation(s)
- Jessica Yu Ting Lu
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Shannon McKinn
- School of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Lucinda Freeman
- School of Women and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Carissa Bonner
- School of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
- Corresponding author at: Sydney School of Public Health, Edward Ford Building (A27), The University of Sydney, NSW 2006, Australia.
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Ferrari A, Pirrotta L, Bonciani M, Venturi G, Vainieri M. Higher readability of institutional websites drives the correct fruition of the abortion pathway: A cross-sectional study. PLoS One 2022; 17:e0277342. [PMID: 36331935 PMCID: PMC9635703 DOI: 10.1371/journal.pone.0277342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background In Italy, abortion services are public: therefore, health Institutions should provide clear and easily readable web-based information. We aimed to 1) assess variation in abortion services utilisation; 2) analyse the readability of institutional websites informing on induced abortion; 3) explore whether easier-to-read institutional websites influenced the correct fruition of abortion services. Methods We identified from the 2021 administrative databases of Tuscany all women having an abortion, and–among them–women having an abortion with the certification provided by family counselling centres, following the pathway established by law. We assessed variation in total and certified abortion rates by computing the Systematic Component of Variation. We analysed the readability of the Tuscan health authorities’ websites using the readability assessment tool READ-IT. We explored how institutional website readability influenced the odds of having certified abortions by running multilevel logistic models, considering health authorities as the highest-level variables. Results We observed high variation in the correct utilization of the abortion pathway in terms of certified abortion rates. The READ-IT scores showed that the most readable text was from the Florence Teaching Hospital website. Multilevel models revealed that higher READ-IT scores, corresponding to more difficult texts, resulted in lower odds of certified abortions. Conclusions Large variation in the proper fruition of abortion pathways occurs in Tuscany, and such variation may depend on readability of institutional websites informing on induced abortion. Therefore, health Institutions should monitor and improve the readability of their websites to ensure proper and more equitable access to abortion.
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Affiliation(s)
- Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant’Anna School of Advanced Studies, Pisa, Tuscany, Italy
- * E-mail:
| | - Luca Pirrotta
- Institute of Management, MeS (Management and Health) Laboratory, Sant’Anna School of Advanced Studies, Pisa, Tuscany, Italy
| | - Manila Bonciani
- Institute of Management, MeS (Management and Health) Laboratory, Sant’Anna School of Advanced Studies, Pisa, Tuscany, Italy
| | - Giulia Venturi
- Institute of Computational Linguistics “A. Zampolli” (ILC-CNR), Italian Natural Language Processing Laboratory (ItaliaNLP Lab), National Research Council, Pisa, Tuscany, Italy
| | - Milena Vainieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant’Anna School of Advanced Studies, Pisa, Tuscany, Italy
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Abstract
Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior and posterior vaginal walls, uterus (cervix), or apex of the vagina (vaginal vault or cuff scar after hysterectomy). Although POP can be asymptomatic, if the bulge extends beyond the opening of the vagina, it can have a significant impact on a woman's quality of life. Findings include vaginal bulging toward or through the vaginal introitus that the patient may feel, palpate, or see with a mirror. If a woman is bothered by her prolapse, she should be offered both nonsurgical and surgical treatments.
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Affiliation(s)
- Sarah Collins
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and reconstructive Surgery Northwestern University, Feinberg School of Medicine Chicago, 250 E. Superior, Chicago, IL 60611, USA
| | - Christina Lewicky-Gaupp
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and reconstructive Surgery Northwestern University, Feinberg School of Medicine Chicago, 250 E. Superior, Chicago, IL 60611, USA.
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Poulin Herron A, Agbadje TT, Guay-Bélanger S, Ngueta G, Roch G, Rousseau F, Légaré F. Web-Based Training for Nurses on Using a Decision Aid to Support Shared Decision Making about Prenatal Screening: a Controlled Trial. JMIR Nurs 2021; 5:e31380. [PMID: 34874274 PMCID: PMC8826152 DOI: 10.2196/31380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nurses play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision-making (SDM) training program for health professionals focusing on Down syndrome screening decisions. Objective In this study, we aim to assess the impact of an SDM training program on nurses’ intention to use a decision aid with pregnant women deciding on prenatal screening for Down syndrome. Methods In this 2-arm, parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was the intention to use a decision aid. Secondary outcomes were psychosocial variables of intention, knowledge, satisfaction, acceptability, perceived usefulness, and reaction to the pedagogical approach. All outcomes were self-assessed through web-based questionnaires, including the space for written comments. We used 2-tailed Student t test and Fisher exact test to compare continuous and categorical variables between groups, respectively. Results Of the 57 participants assessed for eligibility, 40 (70%) were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. The mean age of the participants was 41 (SD 9) years. Most were women (39/40, 98%), White (38/40, 95%), clinical nurses (28/40, 70%), and had completed at least a bachelor’s degree (30/40, 75%). After the intervention, the mean score of intention was 6.3 (SD 0.8; 95% CI 5.9-6.7) for the intervention group and 6.0 (SD 1.2; 95% CI 5.42-6.64) for the control group (scale 1-7). The differences in intention and other psychosocial variable scores between the groups were not statistically significant. Knowledge scores for SDM were significantly higher in the intervention group (79%, 95% CI 70-89 vs 64%, 95% CI 57-71; P=.009). The intervention was significantly more acceptable in the intervention group (4.6, 95% CI 4.4-4.8 vs 4.3, 95% CI 4.1-4.5; P=.02), and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7, 95% CI 4.5-4.8 vs 4.4, 95% CI 4.2-4.5; P=.02). There was no significant difference in overall satisfaction (or in perceived usefulness). Furthermore, 17 participants (9 in the intervention group and 8 in the control group) provided written comments on the intervention. Conclusions This study focuses on web-based nursing education and its potential to support pregnant women’s decision-making needs. It shows that nurses’ intention to use a decision aid to enhance SDM in prenatal care is high, with or without training, but that their knowledge about SDM can be improved with web-based training. International Registered Report Identifier (IRRID) RR2-10.2196/17878
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Affiliation(s)
- Alex Poulin Herron
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Faculty of Nursing, Université Laval, Quebec, CA
| | - Titilayo Tatiana Agbadje
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA
| | - Sabrina Guay-Bélanger
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA
| | - Gérard Ngueta
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Department of Epidemiology, Faculty of Medicine, Université Laval, Quebec, CA
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec, CA.,Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA
| | - François Rousseau
- Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA.,Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec, CA
| | - France Légaré
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, CA
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9
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Kirubarajan A, Lam A, Yu A, Taheri C, Khan S, Sethuram C, Mehta V, Olivieri N. Knowledge, Information Sources, and Institutional Trust of Patients Regarding Medication Use in Pregnancy: A Systematic Review. J Family Reprod Health 2021; 15:160-171. [PMID: 34721607 PMCID: PMC8536826 DOI: 10.18502/jfrh.v15i3.7133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The objective of our study is to characterize the knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy. Materials and methods: We conducted a review of three databases: MEDLINE, EMBASE, and CINAHL. We included observational studies and knowledge assessments that examined the knowledge, attitudes, beliefs or information sources of pregnant patients related to medication use during pregnancy. Extraction was completed by two independent reviewers, outcomes were summarized descriptively, and appraisal was conducted. Results: Of the 1359 search results, 34 studies met inclusion criteria. Thus, our systematic review encompasses the beliefs of 11,757 pregnant participants. In most studies, participants described apprehension regarding potential risks to the fetus and the inadequacy of safety information. Across the 23 knowledge assessments, the majority of studies reported patient misconceptions about prescription medication in pregnancy. The most preferred information source was a healthcare provider. However, many participants expressed frustration, mistrust, and skepticism regarding physician knowledge. A common source of mistrust was due to perceived physician self-interest as well as a lack of education tailored to pregnancy. Consequently, informal sources of information were also popular. Conclusion: There is a need to improve the health literacy and trust among pregnant patients regarding drug prescribing. There are modifiable risk factors for mistrust that require further attention.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Taheri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Sethuram
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vikita Mehta
- Arts and Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Olivieri
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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10
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Lemmens SMP, van Montfort P, Meertens LJE, Spaanderman MEA, Smits LJM, de Vries RG, Scheepers HCJ. Perinatal factors related to pregnancy and childbirth satisfaction: a prospective cohort study. J Psychosom Obstet Gynaecol 2021; 42:181-189. [PMID: 31913725 DOI: 10.1080/0167482x.2019.1708894] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Satisfaction of pregnancy and childbirth is an important quality measure of maternity care. Satisfaction questionnaires generally result in high scores. However, it has been argued that dissatisfaction relies on a different construct. In response to a worldwide call for obstetric care that is more woman-centered, we identified and described the contributors to suboptimal satisfaction with pregnancy and childbirth. METHODS A prospective subcohort of 739 women from a larger cohort (Expect Study I, n = 2614) received a pregnancy and childbirth satisfaction questionnaire. Scores were transformed to a binary outcome whereby a score <100 points corresponded with less satisfied women. We performed a multiple logistic regression analysis to define independent perinatal factors related to suboptimal satisfaction. RESULTS Decreased perceived personal well-being, antenatal anxiety, and obstetrician-led care during labor were all independently associated with suboptimal pregnancy and childbirth satisfaction. No difference in satisfaction was found between antenatal care led by a midwife or an obstetrician, but midwife-led antenatal care reduced the odds of suboptimal satisfaction compared to women who were transferred to an obstetrician in the antenatal period. Antenatal anxiety was experienced by 25% of all women and is associated with decreased satisfaction scores. DISCUSSION Screening and treatment of women suffering from anxiety might improve pregnancy and childbirth satisfaction, but further research is necessary. Women's birthing experience may improve by reducing unnecessary secondary obstetric care.
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Affiliation(s)
- Stéphanie M P Lemmens
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pim van Montfort
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Linda J E Meertens
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luc J M Smits
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Raymond G de Vries
- Research Center for Midwifery Science Maastricht, Zuyd University, Maastricht, The Netherlands.,Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hubertina C J Scheepers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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11
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Aarts JWM, Thompson R, Alam SS, Dannenberg M, Elwyn G, Foster TC. Encounter decision aids to facilitate shared decision-making with women experiencing heavy menstrual bleeding or symptomatic uterine fibroids: A before-after study. PATIENT EDUCATION AND COUNSELING 2021; 104:2259-2265. [PMID: 33632633 DOI: 10.1016/j.pec.2021.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/19/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?. METHODS This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION5. Consultation transcripts in the 'after' group were checked for adherence to the steps required for intended use of decision aids. RESULTS 16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53-19.47). CONCLUSION The level of SDM was higher after the introduction of the package than before. PRACTICE IMPLICATIONS This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.
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Affiliation(s)
- Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, the Netherlands.
| | - Rachel Thompson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Shama S Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Michelle Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Tina C Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA; Department Obstetrics & Gynaecology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Tucker Edmonds B, Hoffman SM, Laitano T, Coleman-Phox K, Castillo E, Kuppermann M. User-testing of a decision-support tool for parents facing threatened periviable delivery: The Periviable GOALS decision aid. PATIENT EDUCATION AND COUNSELING 2021; 104:1286-1294. [PMID: 33162273 PMCID: PMC9664996 DOI: 10.1016/j.pec.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/19/2020] [Accepted: 10/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND To report user-centered design methods and stakeholder acceptability ratings of the Periviable GOALS (Getting Optimal Alignment around Life Support) decision aid (DA). METHODS 'Experienced' and 'expectant' mothers engaged in content and design refining sessions. Five videos (10 families) were embedded in the DA to highlight life after delivery. User-testing sessions were conducted with mothers and providers to assess acceptability. End-user testing was conducted with hospitalized women facing potential periviable delivery to assess acceptability and feasibility in the clinical setting. RESULTS 108 participants engaged in sessions from July 2017-January 2020. Twenty-seven refining sessions resulted in a DA providing survival estimates, neonatal outcomes descriptions, and values clarification exercises. Five white and five black women participated in the videos; six having surviving children (ages 16 months-4 years). Twelve mothers, 16 providers, and six hospitalized women evaluated acceptability. 95.1 % found the content "just right," 94.9 % rated the videos "good" or "excellent," and 97.2 % believed GOALS would support families in periviable decision-making. CONCLUSION Our results highlight the importance of developing a DA that is acceptable for patient use with direct involvement of stakeholders. PRACTICE IMPLICATIONS The GOALS DA may prepare families to engage in shared decision-making to facilitate more patient-centered models of periviable care.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA.
| | - Shelley M Hoffman
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Tatiana Laitano
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 550 16th St, Box 0132, San Francisco, CA, 94143, USA
| | - Esperanza Castillo
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 550 16th St, Box 0132, San Francisco, CA, 94143, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 550 16th St, Box 0132, San Francisco, CA, 94143, USA
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Telfer M, Illuzzi J, Jolles D. Implementing an Evidence-Based Bundle to Reduce Early Labor Admissions and Increase Adherence to Labor Arrest Guidelines: A Quality Improvement Initiative. J Dr Nurs Pract 2021; 14:JDNP-D-20-00026. [PMID: 34006599 DOI: 10.1891/jdnp-d-20-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND At many hospitals, the cesarean birth rate among nulliparous term singleton vertex (NTSV) pregnancies is higher than World Health Organization benchmarks. Reducing NTSV cesarean birth is a national quality imperative. The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth. METHODS Chart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks. RESULTS The bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%. CONCLUSIONS Implementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines. IMPLICATIONS FOR NURSING Implementation of evidence-based bundles has the potential to achieve meaningful quality improvements in maternity care.
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14
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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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15
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Carlisle N, Watson HA, Kuhrt K, Carter J, Seed PT, Tribe RM, Sandall J, Shennan AH. Ten women's decision-making experiences in threatened preterm labour: Qualitative findings from the EQUIPTT trial. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100611. [PMID: 33882392 DOI: 10.1016/j.srhc.2021.100611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/15/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical triage of women in threatened preterm labour (TPTL) could be improved through utilising the QUiPP App, as symptoms alone are poor predictors of early delivery. As most women in TPTL ultimately deliver at term, they must weigh this likelihood with their own personal considerations, and responsibilities. The importance of personal considerations was highlighted by the 2015 Montgomery ruling, and the significance of shared decision-making. AIMS Through qualitative interviews, the primary aim was to explore women's decision-making experiences in TPTL through onset of symptoms, triage, clinical assessment, and discharge. METHODS Qualitative interviews were undertaken as part of the EQUIPTT study (REC: 17/LO/1802) using a semi-structured interview schedule. Descriptive labels of the coding scheme were applied to the raw transcript data. This coding scheme was then increasingly refined into key themes and allowed parallels to be made within and between cases. RESULTS Ten ethnically diverse women who presented at six different London hospitals sites in TPTL were interviewed. Three final themes emerged from the data incorporating 10 sub-themes, 'Seeking help', 'Being "assessed" vs making clinical decisions together', and 'End result.' CONCLUSION Women described their busy lives and the need to juggle their commitments. Participants drew comparisons between their TPTL symptoms and 'period pain,' contrasting to typical medical terminology. Shared decision-making and the clinician-patient relationship could be improved through clinicians utilizing terminology women understand and relate to. Women used language that highlighted the clinician-patient power balance. While not fully involved in shared decision-making, women were overall satisfied with their care.
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Affiliation(s)
- N Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom.
| | - H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - K Kuhrt
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
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16
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Bussink-Legters AG, den Hoogen AV, Veersema S, Meijer WJ, Ockhuijsen HDL. The Needs of Dutch Women During Decision-Making About Treatment for Miscarriage. J Obstet Gynecol Neonatal Nurs 2021; 50:439-449. [PMID: 33753091 DOI: 10.1016/j.jogn.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To explore the needs of women during decision-making about treatment for miscarriage. DESIGN Descriptive qualitative design. SETTINGS University and teaching hospitals in the Netherlands. PARTICIPANTS We selected a purposive sample of 16 women who needed treatment for miscarriage from an electronic patient file system. We ensured maximum variation by sampling in different hospitals and selecting women with different ages, numbers of children, miscarriage histories, treatment types, and educational levels. METHODS We conducted face-to-face individual, semistructured interviews and used thematic analysis to identify, analyze, and describe themes. RESULTS We identified one overarching theme, Decision Based on Reason and Emotion, and three related subthemes: Certainty, Information, and SupportFrom Environment. CONCLUSION Health care professionals should be aware of how women's decision-making is structured in the context of treatment choices for miscarriage, and discussion regarding treatment should address reason and emotion.
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17
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Impact of a Web-Based Decisional Aid on Satisfaction in Women Undergoing Prolapse Surgery. Female Pelvic Med Reconstr Surg 2021; 27:e309-e314. [PMID: 33009264 DOI: 10.1097/spv.0000000000000916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether a computerized, condition-specific Decision Analysis Tool (DAT) for the surgical treatment of pelvic organ prolapse (POP) improves patient satisfaction and alters decision making. METHODS Together with a health care startup company, we created a computerized DAT using the best evidence available on success rates and risks associated with sacrocolpopexy, native tissue apical suspension, and colpocleisis. Consecutively scheduled women before and after implementation of the DAT in an academic practice of 4 fellowship-trained, board-certified urogynecologists were included. The primary outcome was patient satisfaction using the Satisfaction with Decision Scale (SDS). Secondary outcomes included the Decision Regret Scale (DRS) questionnaire, differences in surgical choice, patient-reported outcomes, and individual SDS and DRS items. The SDS and DRS were administered at the 3-month postoperative visit. RESULTS Forty-seven women before DAT implementation and 54 women after DAT implementation were included. There were no differences in SDS or DRS total scores (4.62 ± 0.66 vs 4.52 ± 0.72, P = 0.10 and 1.48 ± 0.79 vs 1.52 ± 0.82, P = 0.77) or individual question responses between groups. Women using the DAT were more likely to choose sacrocolpopexy than those who did not (76% vs 51%, P = 0.01). All 3 procedures led to similarly improved POP symptoms (P = 0.98), but those who underwent sacrocolpopexy had higher SDS scores compared with native tissue or colpocleisis patients (P = 0.01). Several individual SDS and DRS items were more favorable after sacrocolpopexy. CONCLUSIONS Women choosing surgery for POP are satisfied with their decision-making experiences with and without the assistance of a DAT. More women using a DAT, however, undergo sacrocolpopexy, which is associated with improved satisfaction.
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18
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Zielinski RE, Roosevelt L, Nelson K, Vargas B, Thomas JW. Relational Decision-Making in the Context of Life-Limiting Fetal Anomalies: Two Cases of Anencephaly Diagnosis. J Midwifery Womens Health 2020; 65:813-817. [PMID: 33247516 DOI: 10.1111/jmwh.13161] [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: 01/29/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
Life-limiting fetal diagnoses such as anencephaly require families to make decisions in which no options offered will lead to the desired outcome of a healthy newborn. Although informed choice and shared decision-making are important aspects of ethics regarding care choices, they have limitations. In this article, 2 cases of anencephaly diagnosis are presented, and a relational decision-making model of care is proposed as an alternative for aiding pregnant people and their families in making challenging choices in the context of perinatal care.
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Affiliation(s)
| | - Lee Roosevelt
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Kathryn Nelson
- School of Nursing, University of Michigan, Ann Arbor, Michigan
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19
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Wang R, van Eekelen R, Mochtar MH, Mol F, van Wely M. Treatment Strategies for Unexplained Infertility. Semin Reprod Med 2020; 38:48-54. [PMID: 33124018 DOI: 10.1055/s-0040-1719074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Unexplained infertility is a common diagnosis among couples with infertility. Pragmatic treatment options in these couples are directed at trying to improve chances to conceive, and consequently intrauterine insemination (IUI) with ovarian stimulation and in vitro fertilization (IVF) are standard clinical practice, while expectant management remains an important alternative. While evidence on IVF or IUI with ovarian stimulation versus expectant management was inconclusive, these interventions seem more effective in couples with a poor prognosis of natural conception. Strategies such as strict cancellation criteria and single-embryo transfer aim to reduce multiple pregnancies without compromising cumulative live birth. We propose a prognosis-based approach to manage couples with unexplained infertility so as to expose less couples to unnecessary interventions and less mothers and children to the potential adverse effects of ovarian stimulation or laboratory procedures.
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Affiliation(s)
- Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Rik van Eekelen
- Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Monique H Mochtar
- Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Femke Mol
- Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Madelon van Wely
- Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
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20
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Nielsen JH, Lykke JA. Differentiated timing of induction for women with intrahepatic cholestasis of pregnancy-A historical cohort study. Acta Obstet Gynecol Scand 2020; 100:279-285. [PMID: 32970824 DOI: 10.1111/aogs.13998] [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: 05/29/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease characterized by pruritus and abnormal liver function tests and it has been associated with intrauterine fetal distress and stillbirth. We compared two guidelines of the management of ICP: one mandating induction at 38 weeks of gestation (Rigshospitalet and Hvidovre Hospital before 2012) and another separating ICP into mild and severe forms, and only women with severe ICP were recommended for induction at 38 weeks (Hvidovre Hospital after 2012). MATERIAL AND METHODS We performed a historical cohort study at two Copenhagen Hospitals from 2004 to 2015. We included 62 937 women with singleton deliveries at Rigshospitalet and 71 015 at Hvidovre Hospital, of whom 971 women (1.5%) and 998 women (1.4%) were diagnosed with ICP at Rigshospitalet and Hvidovre Hospital, respectively. Data were retrieved from a local medical database. For the analysis of induction and comparison of obstetrical outcomes we only included pregnancies with an ICP diagnosis and excluded women with other medical conditions that could mandate induction. Main outcome measures were induction and cesarean section rates, asphyxia and stillbirth. RESULTS We found no changes in the rate of spontaneous labor, cesarean section and induction over the years at Rigshospitalet (P = .17) and Hvidovre Hospital (P = .38). For women with intended vaginal delivery we found no change in the final mode of delivery over the years at Rigshospitalet (P = .28) and Hvidovre Hospital (P = .57). CONCLUSIONS The two approaches to the management of mild ICP regarding the timing of induction are comparable. Women with mild ICP and their clinicians should be encouraged to engage in shared decision-making when discussing timing of induction.
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Affiliation(s)
| | - Jacob Alexander Lykke
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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21
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Chan MH, Hauck Y, Kuliukas L, Lewis L. Women's experiences of their involvement around care decisions during a subsequent pregnancy after a previous caesarean birth in Western Australia. Women Birth 2020; 34:e442-e450. [PMID: 33004288 DOI: 10.1016/j.wombi.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women who have a caesarean birth can have an experience that may impact decision-making for subsequent births. For some women this decision-making can be associated with anxiety. AIM To provide rich, surface level descriptions by exploring women's experiences of their involvement in decision-making during a subsequent pregnancy after a previous caesarean birth. METHODS A descriptive qualitative study was performed between May 2018 and February 2019 using Braun and Clarke's six steps guided analysis. Pregnant women with a previous caesarean birth, receiving antenatal care at a tertiary maternity hospital in Western Australia, and self-reported low to moderate levels of anxiety were invited to participate in a telephone interview. FINDINGS Women's (n = 17) experiences revealed four themes: 1) Learning from past experiences (two sub-themes loss of control and coming to terms), 2) Claiming ownership in decisions (two sub-themes challenging professional judgement and prioritising her needs, wishes and preferences), 3) Being empowered (three sub-themes getting a full picture, speaking out, and not just the baby or a number), 4) Moving forward (two sub-themes building trust in health professionals and establishing guardrails to minimise loss of control). DISCUSSION Women's experiences around decision-making in a subsequent pregnancy can vary according to whether their fears and anxieties are acknowledged and addressed. Women who are informed, and receive support and respect are empowered to move forward. CONCLUSION Continuity of care may provide women with more opportunities to build trusting relationships with clinicians and be truly known as an individual with unique preferences and desires.
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Affiliation(s)
- Maria Hakyung Chan
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Lesley Kuliukas
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
| | - Lucy Lewis
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley WA 6102, Australia.
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22
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Georgsson S, Carlsson T. Readability of web-based sources about induced abortion: a cross-sectional study. BMC Med Inform Decis Mak 2020; 20:102. [PMID: 32503524 PMCID: PMC7275615 DOI: 10.1186/s12911-020-01132-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background High-quality information is essential if clients who request an abortion are to reach informed decisions and feel prepared for the procedure, but little is known concerning the readability of web-based sources containing such material. The aim was to investigate the readability of web-based information about induced abortion. Methods The search engine Google was used to identify web pages about induced abortion, written in the English language. A total of 240 hits were screened and 236 web pages fulfilled the inclusion criteria. After correcting for duplicate hits, 185 web pages were included. The readability of the text-based content of each web page was determined with Flesch Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook, and Flesch Reading Ease. Data were analyzed with descriptive statistics, Pearson’s correlation coefficient and Kruskal-Wallis with Dunn’s test as post hoc analysis. Results Across all grade level measures, a small minority of the web pages had a readability corresponding to elementary school (n < 3, 1%), while the majority had readability corresponding to senior high school or above (n > 153, 65%). The means of the grade level measures ranged between 10.5 and 13.1, and the mean Flesch Reading Ease score was 45.3 (SD 13.6). Only weak correlations (rho < 0.2) were found between the readability measures and search rank in the hit lists. Consistently, web pages affiliated with health care had the least difficult readability and those affiliated with scientific sources had the most difficult readability. Conclusions Overall, web-based information about induced abortions has difficult readability. Incentives are needed to improve the readability of these texts and ensure that clients encounter understandable information so that they may reach informed decisions and feel adequately prepared when requesting an abortion.
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Affiliation(s)
- Susanne Georgsson
- The Swedish Red Cross University College, Huddinge, Sweden.,Department of Clinical science, Intervention and technology, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Carlsson
- The Swedish Red Cross University College, Huddinge, Sweden. .,Department of Women's and Children's Health, Uppsala university, MTC-huset, Dag Hammarskjölds väg 14B, 1 tr, SE-75237, Uppsala, Sweden.
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23
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Links AR, Callon W, Wasserman C, Walsh J, Tunkel DE, Beach MC, Boss EF. Parental role in decision-making for pediatric surgery: Perceptions of involvement in consultations for tonsillectomy. PATIENT EDUCATION AND COUNSELING 2020; 103:944-951. [PMID: 31866196 DOI: 10.1016/j.pec.2019.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/20/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Parental role in decision-making has implications for quality of care. We describe roles of parent participation in decision-making for tonsillectomy. METHODS Parents reported preferred role in decision-making before consultations for tonsillectomy and the role they experienced after their consult. Parents completed questionnaires, including items evaluating clinician/parent communication. Clinicians rated perception of parents' preferred role in decision-making. Congruence between parent and clinician responses was evaluated via kappa analysis. Logistic regression identified associations between decision-making roles and socioemotional and communication factors. RESULTS Consults between 63 parents and 8 otolaryngologists were analyzed.There was inadequate agreement between clinician and parent ratings of preferred roles (37%, p = 0.6, 95% CI [-0.09, 0.001]). Parents perceived greater involvement when clinicians discussed reasons to have (OR = 4.3, p = 0.03) or not have (OR = 4.1, p = 0.005) surgery. Parents perceived less involvement when clinicians used jargon (OR = 0.1, p = 0.03), and when parents trusted clinicians (OR = 0.4, p = 0.049), or experienced greater decisional conflict (OR = 0.9, p = 0.03). CONCLUSIONS Parents and clinicians perceived parental preference for decision-making involvement differently during consultations for tonsillectomy. Clinician information-sharing, jargon use, and parent trust in clinician predicted extent of perceived engagement. PRACTICE IMPLICATIONS Findings may enhance understanding of strategies to effectively communicate and engage parents in shared decision-making for pediatric surgical care.
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Affiliation(s)
- Anne R Links
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA.
| | - Wynne Callon
- Harvard Medical School, Boston Children's Hospital, Boston, USA
| | - Carly Wasserman
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Jonathan Walsh
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - David E Tunkel
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - Mary Catherine Beach
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
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Kerns JL, Turk JK, Corbetta-Rastelli CM, Rosenstein MG, Caughey AB, Steinauer JE. Second-trimester abortion attitudes and practices among maternal-fetal medicine and family planning subspecialists. BMC Womens Health 2020; 20:20. [PMID: 32013926 PMCID: PMC6998287 DOI: 10.1186/s12905-020-0889-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive. We sought to compare maternal-fetal medicine (MFM) and family planning (FP) physicians' attitudes and practice patterns around second-trimester abortion for abnormal pregnancies. METHODS We surveyed members of the Society for Maternal-Fetal Medicine and Family Planning subspecialists in 2010-2011 regarding provider recommendations between D&E or induction termination for various case scenarios. We assessed provider beliefs about patient preferences and method safety regarding D&E or induction for various indications. We compared responses by specialty using descriptive statistics and conducted unadjusted and adjusted analyses of factors associated with recommending a D&E. RESULTS Seven hundred ninety-four (35%) physicians completed the survey (689 MFMs, 105 FPs). We found that FPs had 3.9 to 5.5 times higher odds of recommending D&E for all case scenarios (e.g. 80% of FPs and 41% of MFMs recommended D&E for trisomy 21). MFMs with exposure to family planning had greater odds of recommending D&E for all case scenarios (p < 0.01 for all). MFMs were less likely than FPs to believe that patients prefer D&E and less likely to feel that D&E was a safer method for different indications. CONCLUSION Recommendations for D&E or induction vary significantly depending on the type of physician providing the counseling. The decision to undergo D&E or induction is one of clinical equipoise, and physicians should provide unbiased counseling. Further work is needed to understand optimal approaches to shared decision making for this clinical decision.
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Affiliation(s)
- J. L. Kerns
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
| | - J. K. Turk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
| | - C. M. Corbetta-Rastelli
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA
| | - M. G. Rosenstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA
| | - A. B. Caughey
- Department of Obstetrics and Gynecology of Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 USA
| | - J. E. Steinauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110 USA
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25
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Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology. Obstet Gynecol 2020; 135:444-451. [DOI: 10.1097/aog.0000000000003664] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Farrell RM, Agatisa PK, Michie MM, Greene A, Ford PJ. The personal utility of cfDNA screening: Pregnant patients' experiences with cfDNA screening and views on expanded cfDNA panels. J Genet Couns 2019; 29:88-96. [PMID: 31680382 DOI: 10.1002/jgc4.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 01/13/2023]
Abstract
Prenatal cell-free DNA screening (cfDNA) provides more genetic risk information about the fetus than has ever been possible. At the same time, the rapid expansion of new cfDNA panels raises important questions about how to structure patient-centered discussions that best support patients' decision-making about its use. To address this question, we conducted interviews with pregnant patients to identify decision-making needs and preferences with respect to cfDNA in patient-centered healthcare discussions, given its evolving capability to identify a range of fetal variants. Personal utility was a core concept guiding decision-making. Participants spoke of how their deeply personal values and beliefs about maternal responsibility, actionability, and tolerance of uncertainty framed their view of the personal utility of cfDNA screening. While discussing their notions of personal utility with their healthcare provider, participants also had concerns about potential ramifications for the provider-patient relationship and shared decision-making when disclosing values and preferences regarding disability, quality of life, and termination-particularly as it becomes possible to identify variants with different disease-associated severity and outcomes. The complexities associated with the introduction of genomics in prenatal care present unique challenges to structuring effective shared decision-making discussions between patients and their healthcare providers. While efforts are underway to determine how to best educate patients about the medical aspects of cfDNA, it is equally important to develop approaches in healthcare communication that enable patients to make informed, values-based decisions about the use of cfDNA and its impact on their pregnancy.
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Affiliation(s)
- Ruth M Farrell
- OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
| | | | - Marsha M Michie
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio
| | - Amy Greene
- Center for Spiritual Care, Cleveland Clinic, Cleveland, Ohio
| | - Paul J Ford
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
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Pellowski JA, Weber AZ, Phillips TK, Brittain K, Zerbe A, Abrams EJ, Myer L. "You must leave but I didn't want to leave": qualitative evaluation of the integration of ART into postnatal maternal and child health services in Cape Town, South Africa. AIDS Care 2019; 32:480-485. [PMID: 31455090 DOI: 10.1080/09540121.2019.1659913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Postpartum HIV care retention rates are well below retention rates of the general adult population. The Maternal-Child Health Antiretroviral Therapy (MCH-ART) trial tested the benefit of integrating postpartum maternal ART and pediatric care through the end of breastfeeding compared to the standard of care of immediate postpartum referral of mother and infant to separate services. After the trial, twenty-one participants completed in-depth interviews to understand the acceptability of the service integration and the potentially differing "lived" experiences of the women randomized to the two conditions. Key findings include: (1) the MCH-ART integrated service was found to be acceptable, (2) women in the intervention condition expressed more negative feelings around the need to be transferred to general ART services and (3) women in the intervention condition perceived that they had more influence in selecting the clinic to which they would be transferred compared to those in the control group, although there was no actual difference by study design. Future work should more directly evaluate the impact of shared decision-making and long-term relationships with clinic staff on patient engagement and retention in HIV care.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.,International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Alison Z Weber
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Hormonal contraception, breastfeeding and bedside advocacy: the case for patient-centered care. Contraception 2018; 99:73-76. [PMID: 30423320 DOI: 10.1016/j.contraception.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022]
Abstract
Postpartum contraceptive decision making is complex, and recommendations may be influenced by breastfeeding intentions. While biologically plausible, concerns about the adverse impact of hormonal contraception on breast milk production have not been supported by the clinical evidence to date. However, the data have limitations, which can lead providers with different priorities around contraception and breastfeeding to interpret the data in a way that advances their personal priorities. Discrepancies in interpretations can lead to divergent recommendations for individual women and may cause conflict. Furthermore, providers must recognize that decision making about contraception and breastfeeding takes place in complex cultural, historical and socioeconomic contexts. Implicit bias may influence a provider's counseling. Unrecognized biases toward one patient or another, or one practice or another, may influence a provider's counseling. It is crucial for providers to strive to recognize their own biases. Providers need to respectfully recognize each patient's values and preferences regarding hormonal contraception and breastfeeding. Developing a patient-centered decision tool or implementing patient-centered interview techniques specifically around breastfeeding and contraception could help to minimize provider-driven variability in care.
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King TL, Likis FE, Wilson-Liverman AM. Shared Decision Making: Misconstrued and Misused. J Midwifery Womens Health 2018; 63:257-258. [DOI: 10.1111/jmwh.12763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 12/01/2022]
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Abstract
The clinical integration of prenatal genetic technologies raises a series of important medical and ethical considerations for patients, families, health care providers, health care systems, and society. It is critical to recognize, understand, and address these issues in conjunction with the continued development of new prenatal genetic screens and tests. This article discusses some of the lead ethical issues as a starting point to further understanding their ramifications on patients, families, communities, and health care providers.
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Lazo-Porras M, Bayer AM, Acuña-Villaorduña A, Zeballos-Palacios C, Cardenas-Montero D, Reyes-Diaz M, Naranjo-Caceres M, Malaga G. Perspectives, Decision Making, and Final Mode of Delivery in Pregnant Women With a Previous C-Section in a General Hospital in Peru: Prospective Analysis. MDM Policy Pract 2017; 2:2381468317724409. [PMID: 30288428 PMCID: PMC6125051 DOI: 10.1177/2381468317724409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/29/2017] [Indexed: 11/26/2022] Open
Abstract
Objective: Explore the perspectives, decision-making process, and final mode of delivery among pregnant women with a previous C-section (Cesarean section) in a general public sector hospital in Lima, Peru. Methods: A qualitative prospective study using semistructured interviews at two time points in the outpatient obstetrics and gynecology clinic of a public sector, university-affiliated reference hospital in Lima, Peru. Seventeen adult pregnant women with a prior C-section who were deemed by their attending obstetrician to be candidates for a trial of labor were interviewed. The first interview was between 37 and 38 weeks of pregnancy, and the second interview was 24 to 48 hours after delivery. MAIN OUTCOME MEASURES Predelivery decision-making process and final mode of delivery. Results: Among the 17 participants, about half (9) of the participants stated that the physician explained that they had two approaches for delivery, a trial of labor after C-section (TOLAC) or elective repeated C-section (ERCD). Two women stated that their respective providers explained only one option, either an ERCD or TOLAC. However, 6 women did not receive any information from their providers about their delivery options. Of the 10 participants that decided TOLAC, 8 ended up having a C-section, and of the 7 patients that had planned an ERCD, 1 ended up having a vaginal delivery. Conclusion: Many participants affirmed that they made the decision about their approach of delivery. However, most of the participants that decided a TOLAC ended up having a C-section because of complications during the final weeks of pregnancy or during labor.
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Affiliation(s)
- Maria Lazo-Porras
- Maria Lazo-Porras, MD, CONEVID Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru; e-mail:
| | - Angela M. Bayer
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Ana Acuña-Villaorduña
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Claudia Zeballos-Palacios
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Deborah Cardenas-Montero
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Michael Reyes-Diaz
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Monica Naranjo-Caceres
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - German Malaga
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
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Ryding EL, Lukasse M, Kristjansdottir H, Steingrimsdottir T, Schei B. Pregnant women's preference for cesarean section and subsequent mode of birth - a six-country cohort study. J Psychosom Obstet Gynaecol 2016; 37:75-83. [PMID: 27269591 DOI: 10.1080/0167482x.2016.1181055] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for health care. Women's preferences may vary across countries for psychosocial or obstetric reasons. METHODS A prospective cohort study of 6549 women in routine antenatal care giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records. RESULTS A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth (FOC), with a negative birth experience in multiparous women and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, odd ratio (OR) 1.70 (1.02-2.83), adjusted for age, education, depression, FOC, history of abuse, previous cesarean and negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) delivered by CS, mostly for a medical indication. A total of 9% of the cesareans in the cohort had a non-medical indication only. CONCLUSIONS Women's preference for CS often seems to be due to health concerns. Both medical and psychological factors need to be addressed in antenatal counseling. Obstetricians need to convey accurately to women the risks and benefits of CS in her specific case. Maternity professionals should identify and explore psychosocial reasons for women's preferences.
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Affiliation(s)
- Elsa Lena Ryding
- a Department of Women's and Children's Health, Division of Obstetrics and Gynecology , Karolinska Institutet , Stockholm , Sweden
| | - Mirjam Lukasse
- b Department of Health, Nutrition and Management , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Hildur Kristjansdottir
- c Department of Midwifery, Faculty of Nursing , Landspitali University Hospital , Reykjavik , Iceland ;,d Department of Obstetrics and Gynecology , Landspitali University Hospital , Reykjavik , Iceland
| | - Thora Steingrimsdottir
- d Department of Obstetrics and Gynecology , Landspitali University Hospital , Reykjavik , Iceland
| | - Berit Schei
- e Department of Public Health and General Practice , Norwegian University of Science and Technology , Trondheim , Norway ;,f Department of Obstetrics and Gynecology , St. Olav's University Hospital , Trondheim , Norway
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