Decision aids to improve informed decision‐making in pregnancy care: a systematic review

Vlemmix, Floortje; Warendorf, Janna K; Rosman, AN; Kok, Marjolein; Mol, B.W.; Morris, Jonathan M.; Nassar, Natasha

doi:10.1111/1471-0528.12060

Cited by 120 publications

(118 citation statements)

References 29 publications

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“…A passive flow of information from providers to users was not effective in improving users’ knowledge and awareness about their health condition for shared decision-making 30 40 41. The greatest benefits were observed when a decision support technique was implemented in the form of counselling from a care provider involving information, discussion of options and clarification of values 42. Two reviews found that regular frequent discussions with healthcare providers were more effective than a one-off contact 27 35.…”

Section: Resultsmentioning

confidence: 99%

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

et al. 2014

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ObjectiveConduct a global situational analysis to identify the current facilitators and barriers to improving quality of care (QoC) for pregnant women, newborns and children.Study designMetareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews.SettingsHealth systems of all countries. Study outcome: QoC measured using surrogate indicators––effective, efficient, accessible, acceptable/patient centred, equitable and safe.AnalysisConducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO's framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers.ResultsWe included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO's framework––information, patient–population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, ‘communication’ and ‘satisfaction’, were generated. Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups.ConclusionsThe barriers to good-quality healthcare are common for pregnant women, newborns and children; thus, interventions targeted to address them will have uniform beneficial effects. Adopting the identified facilitators would help countries strengthen their health systems and ensure high-quality care for all.

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Section: Resultsmentioning

confidence: 99%

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

et al. 2014

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“…52,53 The findings of this study add to the growing clinical and epidemiologic evidence that prolonging pregnancy (increasing gestational age), even at term (from 37-38 weeks), can benefit brain 6 To support informed decisionmaking with their pregnancy care provider, it is important for women and their families to have readily available and accessible information about the optimal duration of pregnancy and any increased risk of poorer development or other adverse outcomes associated with early planned birth. 55 This information is relevant given recent research reporting that >90% of women indicated the earliest gestational age for safe delivery was before 39 weeks. 56,57 Furthermore, another study reported that almost half of women thought a cesarean delivery without medical indication should be performed upon request, despite minimal knowledge about the risks and benefits of one.…”

Section: Discussionmentioning

confidence: 99%

Planned Birth Before 39 Weeks and Child Development: A Population-Based Study

et al. 2016

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To investigate the association of gestational age and mode of birth with early child development. METHODS:Population-based record linkage cohort study was conducted among 153 730 liveborn infants of ≥32 weeks' gestation with developmental assessments at school age, in New South Wales, Australia, 2002 to 2007. Children were assessed in 5 domains: physical health and well-being, language and cognition, social competence, emotional maturity, and general knowledge and communication. Children scoring in the bottom 10% of national domains were considered developmentally vulnerable, and children developmentally vulnerable for ≥2 domains were classified as developmentally high risk (DHR), the primary outcome. Robust multivariable Poisson models were used to obtain individual and combined adjusted relative risks (aRRs) of gestational age and mode of birth for DHR children.RESULTS: Overall, 9.6% of children were DHR. The aRR (95% confidence interval) of being DHR increased with decreasing gestational age (referent: 40 weeks); 32 to 33 weeks 1.25 (1.08-1.44), 34 to 36 weeks 1.26 (1.18-1.34), 37 weeks 1.17 (1.10-1.25), 38 weeks 1.06 (1.01-1.10), 39 weeks 0.98 (0.94-1.02), ≥41 weeks 0.99 (0.94-1.03), and for labor induction or prelabor cesarean delivery (planned birth; referent: vaginal birth after spontaneous labor), 1.07 (1.04-1.11). The combined aRR for planned birth was 1.26 (1.18-1.34) at 37 weeks and 1.13 (1.08-1.19) at 38 weeks.CONCLUSIONS: Early (at <39 weeks) planned birth is associated with an elevated risk of poor child development at school age. The timing of planned birth is modifiable, and strategies to inform more judicious decision-making are needed to ensure optimal child health and development.

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“…9 Information and decision aids have been recommended for use in clinical situations in which patient education is necessary for fully informed decision-making. [10][11][12][13] Use of decision aids for prenatal counseling using structured, paper-based or basic electronic tools has been associated with less decision conflict, improved knowledge, and in some cases, increased uptake of prenatal testing. [14][15][16][17][18] Such tools can facilitate an improved informed consent process, yet few decision aids have been developed and evaluated in the United States, particularly for use in low literacy populations.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of a Prenatal Genetic Testing Interactive Computerized Information Aid

Yee

Wolf

Mullen

et al. 2014

Obstetrical &Amp; Gynecological Survey

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OBJECTIVE-To determine whether an interactive computer program could improve patient knowledge regarding genetic screening and diagnostic concepts.METHODS-In this randomized trial, women 6-26 weeks' gestation were assigned to standard care with provider-based counseling or to augmented counseling with an interactive computer program. The computer-based tool conveyed information about genetic testing options. Women were administered a 23-item test of content knowledge immediately and 2-4 weeks after exposure. Test scores were compared between groups at both points using T-tests. RESULTS-150women were randomized equally between groups. Groups were similar with regard to demographic characteristics. Women randomized to the interactive tool correctly answered a significantly greater proportion of questions than those who received standard counseling (69.4% ±14.2% vs. 46.0% ± 15.2%, p<.001) on the immediate questionnaire. One hundred and twenty-three (82%) participants participated in the follow-up test. Women randomized to the tool continued to correctly answer a significantly greater proportion of questions (60.6% ± 16% vs. 49.7% ± 18.9%, p=.001). Education, health literacy, electronic health literacy, and other discussions with providers were not associated with a differential benefit from the educational intervention.

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Decision aids to improve informed decision‐making in pregnancy care: a systematic review

Cited by 120 publications

References 29 publications

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

Planned Birth Before 39 Weeks and Child Development: A Population-Based Study

A Randomized Trial of a Prenatal Genetic Testing Interactive Computerized Information Aid

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