A randomised controlled trial of a decision‐aid leaflet to facilitate women’s choice between pregnancy termination methods

Abstract

Objective To evaluate the effectiveness of a decision aid to help women choose between surgical and medical methods of pregnancy termination.Design A randomised controlled trial comparing a decision-aid leaflet about termination methods with a control leaflet about contraception.Setting An NHS regional centre for pregnancy termination.Sample All women less than 9 weeks of gestation referred for termination of pregnancy over 7 months in 2002.Methods Participants were given an envelope containing either the decision-aid or the control leaflet prior to choosing between medical and surgical termination methods and completed two questionnaires, one immediately after this consultation and another after the termination procedure.Main outcome measures Choice of termination method; measures of effective decision making including risk perception, attitudes and knowledge of both the medical and surgical methods; decisional conflict; anxiety and usefulness of the leaflet.Results Three hundred and twenty-eight women participated. There was no difference in the method chosen between the groups (60/162 women in the decision-aided group chose a medical method versus 54/164 women in the control group (OR 1.2; 95% CI 0.76-1.9). Women in the decision-aided group had higher knowledge and lower risk-perception scores about both methods, more positive attitudes about the medical method, lower decisional conflict, more stable evaluations of the decision information over time and higher perceived usefulness of information ratings. Anxiety was high but unrelated to leaflet type.Conclusions Women made more informed decisions when provided with an evidence-based decision-aid leaflet preceding a routine consultation about choices of termination method.

Examining the attitudes and preferences of health care decision-makers in relation to access, equity and cost-effectiveness: A discrete choice experiment

“…There is evidence to suggest that some simple interventions can be included within a choice task to encourage individuals to adopt a more systematic approach to the evaluation of information [14,15]. This may lead to the formation of more stable preferences which are essentially closer to the underlying compensatory preferences assumed by economists in the analysis of DCE data.…”

Where is the theory? Evaluating the theoretical frameworks described in decision support technologies

“…The decision analytic method, and its direct application, the decision tree [31], have been widely used in designing DSTs for the last 10 years and was first applied to patient counselling in 1979 [32]. This method consists of assigning a cost and a probability of [110,111], 2003 Menorrhagia treatment Booklet Whelan [112], 2003 Breast cancer chemotherapy Decision board + booklet Whelan [113], 2004 Breast cancer surgery Decision board Wolf [114,115], 1996 PSA screening Script Wolf [116], 2000 Colon cancer screening Script Wong [117], 2006 Pregnancy termination Leaflet occurrence to each outcome and to combine them in order to generate the expected cost of each course of action. In the context of DST development, patients are asked to specify the utility of each available health option on a numerical scale.…”

The loss of reason in patient decision aid research: Do checklists damage the quality of informed choice interventions?

“…The evidence is lacking on the range of techniques that enable people to evaluate the information out there with their existing beliefs and/ or whether explicit techniques to enable trade-offs are needed for all decision aids in all contexts [49,50,73,101,103]. We have found that for less difficult decisions (choosing between treatments such as surgical or medical methods of termination of pregnancy), a simpler decision aid was sufficient to encourage more effective reasoning, less decisional conflict and an increased stability in attitudes over time [98]. However, for more difficult decisions (choosing to have or not have a treatment such as prenatal diagnosis), a more complex trade-off technique was required to achieve the same results [96].…”

“…Further, it is possible that such an intervention may be judged as a good patient decision aid because it adhered to the IPDAS checklist even though it was ineffective in facilitating patient decision making. Finally, there are interventions enabling effective patient decision making that do not include all the criteria identified within the IPDAS checklist [1,98,10]. If checklist adherence is used as a judgment about patient decision aid quality, effective patient decision aids could be unjustly rated as poor quality.…”

“…Also, people using decision aids tend to have more robust evaluations of the decision information, less regret, more satisfaction with the decision, and a stronger rationale for their choice [10,26,98]. However, there lacks substantial evidence from the decision scientists on which component parts of a decision aid enable what aspects of good thinking, in which contexts [25,26,29,50,73,78,[99][100][101][102].…”