The Impact of Shared Decision‐Making in Perinatal Care: A Scoping Review

Abstract

Introduction Shared decision‐making is considered to be a key aspect of woman‐centered care and a strategy to improve communication, respect, and satisfaction. This scoping review identified studies that used a shared decision‐making support strategy as the primary intervention in the context of perinatal care. Methods A literature search of PubMed, CINAHL, Cochrane Library, PsycINFO, and SCOPUS databases was completed for English‐language studies conducted from January 2000 through November 2019 that examined the impact of a shared decision‐making support strategy on a perinatal decision (such as choice of mode of birth after prior cesarean birth). Studies that only examined the use of a decision aid were excluded. Nine studies met inclusion criteria and were examined for the nature of the shared decision‐making intervention as well as outcome measures such as decisional evaluation, including decisional conflict, decisional regret, and certainty. Results The 9 included studies were heterogeneous with regard to shared decision‐making interventions and measured outcomes and were performed in different countries and in a variety of perinatal situations, such as women facing the choice of mode of birth after prior cesarean birth. The impact of a shared decision‐making intervention on women's perception of shared decision‐making and on their experiences of the decision‐making process were mixed. There may be a decrease in decisional conflict and regret related to feeling informed, but no change in decisional certainty. Discussion Despite the call to increase the use of shared decision‐making in perinatal care, there are few studies that have examined the effects of a shared decision‐making support strategy. Further studies that include antepartum and intrapartum settings, which include common perinatal decisions such as induction of labor, are needed. In addition, clear guidance and strategies for successfully integrating shared decision‐making and practice recommendations would help women and health care providers navigate these complex decisions.

How is patient‐centred care conceptualized in obstetrical health? comparison of themes from concept analyses in obstetrical health‐ and patient‐centred care

“…A total of 11 PCC and 9 obstetrical care reviews were included. 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 These were from the United States of America ( n = 4), United Kingdom ( n = 3) and Australia, ( n = 2), and one each from Canada, Denmark, Sweden, Ireland, Belgium, German, Tanzania, India, Europe, Iran and South Africa. Studies were published from 2012 to 2021. Review types included concept analysis ( n = 7), systematic review ( n = 9), scoping review ( n = 3), narrative review ( n = 1) and qualitative evidence synthesis (n = 1).…”

“…A total of 11 PCC and 9 obstetrical care reviews were included. [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] These were from the United States of America (n = 4), United Kingdom (n = 3) and Australia, (n = 2), and one each from Canada, Denmark, Sweden, Ireland, Belgium, German, Tanzania, India, Europe, Iran and South Africa. Studies were published from 2012 to 2021.…”

Choosing a Birth Setting: A Shared Decision‐Making Approach

“…A patient decision aid about birth setting options would help guide shared decision‐making between a patient and health care provider, potentially decreasing provider bias about birth settings and supporting the provider's role as informing rather than paternalistically driving the decision 51 . Engaging in a shared decision‐making approach for choosing a birth setting would support people in their assessment of how benefits and risks across birth center, home, and hospital settings best fit within the context of their values, personal health, and available options 2 . People would then be empowered to engage with their health care providers about selecting a birth setting that is both risk‐concordant and values‐based.…”

Induction of labor or expectant management? Birth outcomes for nulliparous individuals choosing midwifery care

“…Furthermore, research is needed to help describe the process of shared decision-making and associated outcomes for people seeking low-intervention models of care with respect to labor induction. 40…”