Shared decision-making and decision support: their role in obstetrics and gynecology

被引:40
作者
Edmonds, Brownsyne Tucker [1 ]
机构
[1] Indiana Univ Sch Med, Dept Obstet & Gynecol, Indianapolis, IN 46202 USA
关键词
decision aids; patient-centered care; patient-clinician communication; shared decision-making; RANDOMIZED CONTROLLED-TRIAL; PREGNANT-WOMEN; PRENATAL-DIAGNOSIS; INFORMED CHOICE; DOWN-SYNDROME; AID; INFORMATION; BREAST; KNOWLEDGE; LEAFLET;
D O I
10.1097/GCO.0000000000000120
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Purpose of review To discuss the role for shared decision-making in obstetrics/gynecology and to review evidence on the impact of decision aids on reproductive health decision-making. Recent findings Among the 155 studies included in a 2014 Cochrane review of decision aids, 31 (29%) addressed reproductive health decisions. Although the majority did not show evidence of an effect on treatment choice, there was a greater uptake of mammography in selected groups of women exposed to decision aids compared with usual care; and a statistically significant reduction in the uptake of hormone replacement therapy among detailed decision aid users compared with simple decision aid users. Studies also found an effect on patient-centered outcomes of care, such as medication adherence, quality-of-life measures, and anxiety scores. In maternity care, only decision analysis tools affected final treatment choice, and patient-directed aids yielded no difference in planned mode of birth after cesarean. Summary There is untapped potential for obstetricians/gynecologists to optimize decision support for reproductive health decisions. Given the limited evidence-base guiding practice, the preference-sensitive nature of reproductive health decisions, and the increase in policy efforts and financial incentives to optimize patients' satisfaction, it is increasingly important for obstetricians/gynecologists to appreciate the role of shared decision-making and decision support in providing patient-centered reproductive healthcare.
引用
收藏
页码:523 / 530
页数:8
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