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Involving women in personalised decision‐making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid
Ist Teil von
BJOG : an international journal of obstetrics and gynaecology, 2014-01, Vol.121 (2), p.202-209
Ort / Verlag
England: Wiley Subscription Services, Inc
Erscheinungsjahr
2014
Quelle
Wiley-Blackwell Journals
Beschreibungen/Notizen
Objective
To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence‐based information.
Design
A PtDA was developed and pilot tested using the International Patients Decision Aid Standards (IPDAS) criteria.
Setting
Obstetric health care in the Netherlands.
Population
A multidisciplinary steering group, an expert panel, and 25 future users of the PtDA, i.e. women with a previous caesarean section.
Methods
The development consisted of a construction phase (defini‐tion of scope and purpose, and selection of content, framework, and format) and a pilot testing phase by interview. The process was supervised by a multidisciplinary steering group.
Main outcome measures
Usability, clarity, and relevance.
Results
The construction phase resulted in a booklet including unbiased balanced information on mode of birth after caesarean section, a preference elicitation exercise, and tailored risk information, including a prediction model for successful VBAC. During pilot testing, visualisation of risks and clarity formed the main basis for revisions. Pilot testing showed the availability of tailored structured information to be the main factor involving women in decision‐making. The PtDA meets 39 out of 50 IPDAS criteria (78%): 23 out of 23 criteria for content (100%) and 16 out of 20 criteria for the development process (80%). Criteria for effectiveness (n = 7) were not evaluated.
Conclusions
An evidence‐based PtDA was developed, with the probability of successful VBAC and the availability of structured information as key items. It is likely that the PtDA enhances the quality of decision‐making on mode of birth after caesarean section.