Shared Decision-Making in Maternity Care

Abstract

Introduction: Shared decision-making (SDM) is a cornerstone of NHS maternity care. Specific challenges exist within pregnancy relating to intrapartum and emergency care. Limited guidance is available to support maternity healthcare professionals’ (MHCPs) in these circumstances. SDM interventions are needed to support MHCPs and improve outcomes for women.
Aims:
1) To perform a systematic review and meta-analysis of interventions to support SDM.
2) To explore MHCPs’ experiences of SDM to improve understanding of SDM practices in maternity care.
Study 1
Methods: Systematic review of quantitative studies evaluating SDM interventions, involving women, birth partners, or MHCPs. Six electronic databases were searched from inception to October 2020. References were screened and data extracted by two researchers. Meta-analyses were performed where >2 similar interventions were evaluated using the same outcome.
Results: 17 studies were included. Interventions were decision aids (n=12) and decision support counselling interventions (n=5). Two interventions targeted intrapartum SDM. No interventions targeted MCHPs. Outcomes were heterogeneous. Decision aids may improve decisional conflict, knowledge and anxiety, but had little to no effect on decision regret, depression, fear of, or attitude to childbirth, perceived directiveness of the consultation, patient involvement in decision-making, and satisfaction. Decision support counselling interventions may reduce overall decisional conflict, there was limited to no evidence on remaining outcomes.
Study 2
Methods: Moderated focus groups with a purposive sample of MHCPs representing differing roles in maternity care. Inductive, reflexive thematic analysis was undertaken.
Results: Seven focus groups (24 participants in total) were undertaken. Two themes were identified: challenges to shared decision-making, and improving decision-making.
Conclusions: SDM is challenging and there are limited evidence-based tools to support it, particularly in intrapartum setting. There is a need to: improve understanding of women’s and MHCPs’ needs, develop interventions targeting them, and undertake high-quality evaluations of them. A Core Outcome Set will enable effective comparison of interventions.

Date of Award	1 Oct 2024
Original language	English
Awarding Institution	University of Bristol
Supervisor	Abigail Fraser (Supervisor), Gemma L Clayton (Supervisor), Anna Davies (Supervisor) & Abi Merriel (Supervisor)