Developing and pre-testing a decision board to facilitate informed choice about delivery approach in uncomplicated pregnancy
Date
2009-10-30
Authors
Milne, Jill
Gafni, Amiram
Lu, Diane
Wood, Stephen
Sauve, Reg
Ross, Sue
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: The rate of caesarean sections is increasing worldwide, yet medical literature informing women with
uncomplicated pregnancies about relative risks and benefits of elective caesarean section (CS) compared with vaginal
delivery (VD) remains scarce. A decision board may address this gap, providing systematic evidence-based information
so that patients can more fully understand their treatment options. The objective of our study was to design and pretest
a decision board to guide clinical discussions and enhance informed decision-making related to delivery approach
(CS or VD) in uncomplicated pregnancy.
Methods: Development of the decision board involved two preliminary studies to determine women's preferred mode
of risk presentation and a systematic literature review for the most comprehensive presentation of medical risks at the
time (VD and CS). Forty women were recruited to pre-test the tool. Eligible subjects were of childbearing age (18-40
years) but were not pregnant in order to avoid raising the expectation among pregnant women that CS was a universally
available birth option. Women selected their preferred delivery approach and completed the Decisional Conflict Scale
to measure decisional uncertainty before and after reviewing the decision board. They also answered open-ended
questions reflecting what they had learned, whether or not the information had helped them to choose between birth
methods, and additional information that should be included. Descriptive statistics were used to analyse sample
characteristics and women's choice of delivery approach pre/post decision board. Change in decisional conflict was
measured using Wilcoxon's sign rank test for each of the three subscales.
Results: The majority of women reported that they had learned something new (n = 37, 92%) and that the tool had
helped them make a hypothetical choice between delivery approaches (n = 34, 85%). Women wanted more information
about neonatal risks and personal experiences. Decisional uncertainty decreased (p < 0.001) and perceived effectiveness
of decisions increased (p < 0.001) post-intervention.
Conclusion: Non-pregnant women of childbearing age were positive about the decision board and stated their
hypothetical delivery choices were informed by risk presentation, but wanted additional information about benefits and
experiences. This study represents a preliminary but integral step towards ensuring women considering delivery
approaches in uncomplicated pregnancies are fully informed.
Description
BioMed Central
Keywords
Citation
Milne et al. Developing and pre-testing a decision board to facilitate informed choice about delivery approach in uncomplicated pregnancy. BMC Pregnancy and Childbirth 2009, 9:50