A project to improve shared decision-making regarding the timing of induction of labor for people with healthy pregnancies at or beyond 39 weeks
Peralta, Ann Warren Church
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BACKGROUND: Medical professional organizations in the U.S. recommend shared decision-making for routine labor induction in healthy term pregnancies. Shared decision-making is part of high quality, person-centered care and has substantial positive impacts. Despite these recommendations for, and impacts of, shared decision-making many people, especially people of color and those who are Medicaid-insured, do not experience shared decision-making concerning induction and according to a 2020 scoping review there are no patient decision aids on this topic. METHODS: We used quality improvement and qualitative methods to develop, test, and refine a patient decision aid on labor induction in healthy pregnancies at or beyond 39 weeks to support shared decision-making. We assessed shared decision-making primarily with these outcomes: patients’ understanding of choices, pros and cons of choices, and their role as primary decision-maker. A quality improvement team developed an initial prototype and used Plan-Do-Study-Act cycles to get patient and provider feedback. The decision aid was tested in three languages by providers across obstetrics, family medicine, and midwifery at a tertiary hospital and two community health centers in Boston, MA between September 2020 and December 2021. RESULTS: Shared decision-making on labor induction in healthy pregnancies was achieved. Across three Plan-Do-Study-Act cycles 24 pregnant people were interviewed. Most were people of color and Medicaid-insured. Many were recent immigrants and/or non-Native English speakers. Nearly all interviewees experienced shared decision making: 23/24 understood their role as the decision-maker. The majority could name two or three choices they had and pros and cons of different choices. Many described the process as empowering and positive. Nine medical providers tested the decision aid and gave feedback. Providers said using the tool helped improve the consistency and content of their counseling and reduce the role of bias. CONCLUSION: A balanced, evidence-based decision aid can support patients and providers in achieving shared decision-making on induction. Quality improvement and qualitative methods were shown effective for decision aid development and can be applied to other topics within and beyond maternity care. Decision aids may be a meaningful part of efforts to improve equity when development, testing, and evaluation centers people with marginalized identities.
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