Table 2 How the consultation was framed – priority of clinical decision narrative

Field note from pre-term birth clinic.

We learn from the HCP that A has had recurrent miscarriages and the issue is whether she wants to undergo cervical cerclage to minimise her risk. The possibility of cerclage has previously been raised with A.

HCP

‘what we need to decide today in whether you want to have a little operation to see if we can prevent another miscarriage or whether you want to hope for the best’. A friendly discussion ensues in which HCP summarises A’s situation including her past history of miscarriages and checks ‘have I missed anything’

A

smiling says ‘no I just don’t know what’s the best thing to do’ but doesn’t want another miscarriage.

HCP

asks if she’s talked it over with husband

A

‘yes endlessly’

HCP

explains option of doing nothing and putting in stitch – explains how stitch can reduce risk of pre-term birth – but no guarantees; very down to earth – factual but kind

Explains 2 types of stitch differences – McDonald and Shirodkar –

A

very attentive – moves to edge of chair…seems to be following but very tense

HCP

lots of eye contact seems to realise A nervous - explains done under general anaesthetic

A

‘I’m terrified of surgery’

HCP

Explains procedure, draws diagram – legs in supports - ‘off to sleep, hold cervix in place with 2 little holder ties like purse strings

A

grimaces, nods

HCP

lot to take on board - any questions no – ‘Have a little think about it whilst I go and get a form’

A (to researcher)

‘I don’t know what to do………..I’m not medical at all so it’s not like I understand what’s best….but she’s so nice she gives me confidence’