SHARED DECISION MAKING IN ANTENATAL OBSTETRICS

Purpose: The UK Government has prioritised shared decision making (SDM) and choice in maternity services, but no studies had explored the breadth of decisions or the feasibility of this aspiration.  Current SDM practice within obstetric consultations had also not been investigated.  This study aimed to describe the decisions made, investigate the factors associated with women’s choice and explore the amount of shared decision making (SDM) taking place. 

Method(s): This cross-sectional study, audio-recorded 194 consultations in a UK district general hospital.  Multi-level regression models were used to investigate associations between choice and doctor, patient, consultation and decision variables.  A small sub-study investigated SDM in two clinical scenarios, using an adapted observer and dyadic OPTION questionnaire.  These were compared using Bland-Altman plots. 

Result(s): 585 decisions were documented with a mean of 3.0 (SD 1.5) per consultation.  No choice was offered in 75% of decisions.  Choice was associated with the decision topic, consultation length, Royal College membership status and presence on the specialist register.  The substudy included 15 consultations and the mean observer OPTION score was 21.9.  Participants rated SDM higher (mean patient OPTION score 65.3).  The Bland-Altman plot demonstrated a small mean difference (-0.07) and one point lay outside the 95% limits of agreement (-0.7, 0.6).    

Conclusion(s): The mean observer OPTION score was comparable with other studies in the field (mean score across eight studies 25.7 (range 16.9 - 53.1)).  However, without a choice it will be challenging for a patient and their healthcare profession to truly share decisions.  If universal SDM is the aim, then further work is required to understand the factors that impact on choice availability and hence SDM.