In the United States, federal acts and regulations, as well as professional guidelines, clearly dictate that every pregnant woman has the right to base her maternity care decisions on accurate, up-todate, comprehensible information. Despite these efforts, evidence suggests that informed consent within current health-care practice is restricted and inconsistently implemented. Patient access to evidence-based research is imperative under the scope of informed consent and is particularly important during a time when perinatal mortality and morbidity rates, interventions, and disparities are on the rise in the United States. This article describes the Coalition for Improving Maternity Services' investigation of the breakdown of informed consent in maternity care.
This study examines the nature of differences in perceptions of decision making between patients and providers about use of epidural analgesia during labor. Thematic analysis was used to identify patterns in written survey responses from 14 patients, 13 labor nurses, and 7 obstetrician-gynecologists. Results revealed patients attempted to place themselves in an informed role in decision making and sought respect for their decisions. Some providers demonstrated paternalism and a tendency to steer patients in the direction of their own preferences. Nurses observed various pressures on decision making, reinforcing the importance of patients being supported to make an informed choice. Differences in perceptions suggest need for improvement in communication and shared decision-making practices related to epidural analgesia use in labor.
The objective of this study was to determine whether differences exist between patient and provider perceptions regarding the decision-making process around use of epidural analgesia during childbirth. The dyadic patient-provider Decisional Confl ict Scale was modifi ed to measure fi rst-time mother ( n ϭ 35) and maternity care provider ( n ϭ 52) perceptions. Providers perceived a greater degree of informed decision making than patients (84.97 vs. 79.41, p ϭ .04) and were more likely to recall they upheld patients' rights to make informed choices than patients were to perceive their rights had been upheld (85.95 vs. 71.73, p Ͻ .01). This incongruity highlights the need to align legal principles with practice to create mutual agreement between stakeholder perceptions of informed decision making.
Background and Purpose: A modified Dyadic Decisional Conflict Scale (D-DCS) and new Patient Rights subscale to measure perceptions of informed decision-making regarding use of epidural analgesia during childbirth are tested. Methods: Thirty-five primiparous women and 52 providers from three hospitals tested the modified instrument. Cronbach’s α coefficient assessed reliability. Mokken scale, principal components, and correlation analyses assessed unidimensionality of subscales. Results: Internal reliability was demonstrated for the D-DCS-Patient (Cronbach’s α = 0.846) and D-DCS-Provider (α = 0.888). Further analyses suggest the Patient Rightssubscale has potential to make a unique contribution to the D-DCS. Conclusions: The modified D-DCS and Patient Rights subscale allow for a more comprehensive study of informed healthcare decision-making that includes legal and ethical elements, which may aid development of targeted interventions to improve decision-making.
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