Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology

Poprzeczny, Amanda J.; Stocking, Katie; Showell, Marian; Duffy, James M N

doi:10.1097/aog.0000000000003664

Cited by 61 publications

(57 citation statements)

References 49 publications

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“…(10-15) "I think the risks for me were the most important like if they were an invasive procedure or not." (10)(11)(12)(13)(14)(15) Financial risks as a component of decision-making "It wasn't gonna make a difference [for the pregnancy outcome.…”

Section: Perceptions Of Risk For a Fetal Genetic Conditionmentioning

confidence: 99%

“…I'd say were like the two main things." (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) Priorities at the first visit and challenges to developing a collaborative agenda "This is my second pregnancy. The first pregnancy I believe they kind of went over everything but … being first time pregnancy and mom, a lot of it seemed kind of foreign."…”

Section: Perceptions Of Risk For a Fetal Genetic Conditionmentioning

confidence: 99%

“…Shared decision-making is an optimal way to structure complex healthcare discussions. [9][10][11] Shared decision-making involves a collaborative agenda setting process in which the priorities of the patient and the provider are shared to structure the visit discussions. 12 Despite the recognized potential to provide key support for prenatal genetic screening and testing options, little is known about how to apply this approach in the prenatal care setting, particularly, at the first prenatal visit.…”

Section: Introductionmentioning

confidence: 99%

“…Perception of risk to the fetus as a result of diagnostic testing was a lead factor in these considerations. As described by these participants, "I think the risks for me were the most important..." (10-15) and "I just wanted to make sure that whatever we did in terms of testing was safe for me and the baby, so that's kind of how we made the decision for what we would have done"(10)(11)(12)(13)(14)(15)(16)(17). Participants placed some types of screening and testing as opposite ends of a risk spectrum.…”

mentioning

confidence: 99%

“…Another participant reflected on the impact of existing healthcare costs for her and her family: "I just didn't want a surprise bill. There's just so many dollar signs enough as it is"(10)(11).For this participant, information about the out-of-pocket costs for screening was just as important as information about the screen's characteristics (eg, what conditions were screened for, detection rate). As she said: I think also something that would have been good to know ahead of time would have been how much it costs.…”

mentioning

confidence: 99%

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Making the most of the first prenatal visit: The challenge of expanding prenatal genetic testing options and limited clinical encounter time

et al. 2020

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Objective Advances in prenatal genetics place additional challenges as patients must receive information about a growing array of screening and testing options. This raises concerns about how to achieve a shared decision‐making process that prepares patients to make an informed decision about their choices about prenatal genetic screening and testing options, calling for a reconsideration of how healthcare providers approach the first prenatal visit. Methods We conducted interviews with 40 pregnant women to identify components of decision‐making regarding prenatal genetic screens and tests at this visit. Analysis was approached using grounded theory. Results Participants brought distinct notions of risk to the visit, including skewed perceptions of baseline risk for a fetal genetic condition and the implications of screening and testing. Participants were very concerned about financial considerations associated with these options, ranking out‐of‐pocket costs on par with medical considerations. Participants noted diverging priorities at the first visit from those of their healthcare provider, leading to barriers to shared decision‐making regarding screening and testing during this visit. Conclusion Research is needed to determine how to restructure the initiation of prenatal care in a way that best positions patients to make informed decisions about prenatal genetic screens and tests.

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Section: Perceptions Of Risk For a Fetal Genetic Conditionmentioning

confidence: 99%

Section: Perceptions Of Risk For a Fetal Genetic Conditionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Making the most of the first prenatal visit: The challenge of expanding prenatal genetic testing options and limited clinical encounter time

et al. 2020

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Interventions to increase access to long-acting reversible contraceptives

Matsushita

Hasegawa

Noma

et al. 2021

Cochrane Database of Systematic Reviews

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“I know my body better than you:” patient focus groups to inform a decision aid on oral corticosteroid use during pregnancy

Palmsten

Bredesen

Kumar

et al. 2020

Pharmacoepidemiology and Drug

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Purpose There is unmet need for decision support regarding medication use during pregnancy. We aimed to inform the development of a decision aid on oral corticosteroid (OCS) use during pregnancy through focus groups. Methods We invited patients from one health system who had a recent live birth and a condition for which OCSs may be prescribed (ie, asthma or other autoimmune disease) to participate in focus groups. We conducted conventional qualitative content analysis of verbatim transcripts of the focus groups using inductive coding. Results There were 30 participants across five focus groups from May to June 2019. Women endorsed the need for patient‐provider discussions about OCS use during pregnancy in which the provider shares risks and benefits and the patient makes her decision. Furthermore, women generally expressed support for patient‐centered handouts about OCS use during pregnancy that the provider discusses with the patient. When considering whether to take OCSs in pregnancy, women had concerns about: the medication's impact on their baby (eg, miscarriage, birth defects, long‐term effects), themselves (eg, effects on mood, sleep, weight gain), pregnancy complications (eg, preterm birth, increased blood pressure), and lactation. Women wanted information on OCSs (eg, indications, length of treatment, and cost), alternative treatments, and risks of not taking OCSs. Conclusions We established patient need for a decision aid on OCS use during pregnancy that providers can discuss with patients. To address patient concerns, the aid should at a minimum describe the medication's impact on baby, including long‐term effects, maternal health, pregnancy complications, and lactation.

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Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology

Cited by 61 publications

References 49 publications

Making the most of the first prenatal visit: The challenge of expanding prenatal genetic testing options and limited clinical encounter time

Making the most of the first prenatal visit: The challenge of expanding prenatal genetic testing options and limited clinical encounter time

Interventions to increase access to long-acting reversible contraceptives

“I know my body better than you:” patient focus groups to inform a decision aid on oral corticosteroid use during pregnancy

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