Satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study

Abstract

Background: The explanation of epidural analgesia by anesthesiologist would often begin after the parturient is admitted to the hospital. Because of labor pain, the decision of receiving epidural analgesia would often be made by the family members, instead of the parturient herself. We aimed to test whether earlier prenatal shared decisionmaking (SDM) interventions increase parturient's comprehension and satisfaction of epidural labor analgesia, compared to conventional explanation after labor pain begun. Methods: During the 28th week of gestation, we provided the SDM parturient health education as well as a leaflet with quick response codes. Scanning the code would link to education videoclips which explained what epidural analgesia is and its advantages and disadvantages. Original routine practice group parturients received explanation of analgesia after admission for delivery. To measure the satisfaction of labor pain service, the accessibility of information, and the communication with medical staff, we designed a questionnaire with reference to (1) Pregnancy and Maternity Care Patients' Experiences Questionnaire (PreMaPEQ), (2) Preterm Birth Experience and Satisfaction Scale (P-BESS), and (3) Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ). The questionnaire was amended after a pretest involving 30 parturients who had received epidural analgesia. Scree test analysis and exploratory factor analysis were performed; then, the questionnaire was revised again. A total of 200 valid questionnaires were collected-100 each from the original routine practice group and the SDM group. Results: The SDM group reported significantly higher satisfaction with and understanding of epidural analgesia, and a significantly higher satisfaction with the information received, and the quality of pain relief. After SDM intervention, significant increasement of the average satisfaction scores in question "my epidural is effective" (9.10%; mean difference: 0.38; 95% confidence interval, 0.17~0.59; p < 0.001) and "The effect of epidural is just as what I have expected" (10.41%; mean difference: 0.41; 95% confidence interval, 0.18~0.64; p < 0.001) was demonstrated.

A Real-Time Artificial Intelligence-Assisted System to Predict Weaning from Ventilator Immediately after Lung Resection Surgery

“…Individualized medicine and precision medicine are trends that will dominate in the future. Individualization can enhance shared decision-making quality before patients make major medical decisions [ 16 , 17 , 44 , 45 ]. Since our prediction system is personalized based on pre-operative data, it may improve the acceptance and comprehension of patients and their families.…”

Co-designing a theory-informed intervention to increase shared decision-making in maternity care

“…Although ‘education’ interventions are also common in SDM, being the basis of 73 of 87 studies included in a Cochrane review [ 29 ], only 37% of these had a positive effect. A recent study of SDM in pain management during labour used educational videos to convey information to patients [ 50 ]. The results were positive, with patients reporting increased understanding of their options, higher satisfaction with the information received, and the quality of pain relief.…”

“…There is robust evidence for the benefits of continuity of care models [55,56]; however, there is limited funding available for health services, with only 8% of patients funded [57]. Waddell et al Health Research Policy and Systems (2023) 21:15 Further strengths of this study include a strong codesign focus, addressing a lack of stakeholder engagement in previous interventions aiming to educate patients on their options, risks and benefits [50,58] and use of behavioural science theory to underpin intervention development, which is rare in maternity care SDM intervention development [25,26,59]. The use of the TDF, BCW and TATT ensured co-designed interventions were based on theory and evidence while being appropriate for the specific context in which they would be employed [32], thus increasing their chance of success compared with interventions designed without theory and evidence [26,29,30].…”

Effectiveness of birth plan counselling based on shared decision making: A cluster randomized controlled trial (APLANT)

“…There are different dimensions of satisfaction with childbirth and the aspects predicting these dimensions [ 30 ], such as the personal control, the perception of choice, self-efficacy, and fulfilment of expectations being of note [ 28 , 30 – 32 ]. Some studies suggest that SDM and the use of support elements for their implementation are related to greater satisfaction with the decision making [ 33 ] in contrast with other studies that do not [ 34 , 35 ]. It should be taken into account that the professionals who attended the childbirth of the women in the study (Hospital) were different from those who carried out the counselling (Primary Care Units), and this might explain the results obtained.…”