Making shared decisions in relation to planned caesarean sections: What are we up to?

Dominiek Coates; Purshaiyna Thirukumar; Amanda Henry

doi:10.1016/j.pec.2019.12.001

Making shared decisions in relation to planned caesarean sections: What are we up to?

Patient Educ Couns. 2020 Jun;103(6):1176-1190. doi: 10.1016/j.pec.2019.12.001. Epub 2019 Dec 5.

Authors

Dominiek Coates¹, Purshaiyna Thirukumar², Amanda Henry³

Affiliations

¹ University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Sydney, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia. Electronic address: Dominiek.Coates@uts.edu.au.
² School of Women's and Children's Health, UNSW Medicine, UNSW, Australia.
³ School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia.

PMID: 31836248
DOI: 10.1016/j.pec.2019.12.001

Abstract

Objective: To map the literature in relation to shared decision making (SDM) for planned caesarean section (CS), particularly women's experiences in receiving the information they need to make informed decisions, their knowledge of the risks and benefits of CS, the experiences and attitudes of clinicians in relation to SDM, and interventions that support women to make informed decisions.

Methods: Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018.

Results: 34 studies were included, with 9750 women and 3313 clinicians. Overall women reported limited SDM, and many did not have the information required to make informed decisions. Clinicians generally agreed with SDM, while recognising it often does not occur. Decision aids and educational interventions were viewed positively by women.

Conclusion: Many women were not actively involved in decision-making. Decision aids show promise as a SDM-enhancing tool. Studies that included clinicians suggest uncertainty regarding SDM, although willingness to engage.

Practice implications: Moving from clinician-led decision-making to SDM for CS has potential to improve patient experiences, however this will require considerable clinician training, and implementation of SDM interventions.

Keywords: Caesarean section; Mode of birth; Patient preferences; Shared decision-making; Unwarranted variation.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Cesarean Section*
Decision Making
Decision Making, Shared*
Female
Humans
Patient Participation
Pregnancy