Patient decision aid for trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery: a quasi-experimental pre-post study

Table 2 Frequency of shared decision making, patient knowledge, and making an informed, patient-centered decision comparing routine care vs. patient decision aid groups

Outcome measures	Routine care	Patient decision aid	P-value⁴
Outcome measures	N = 50	N = 50	P-value⁴
Primary outcomes:
Shared Decision Making Process (SDMP) score, median (IQR)^b.c (n = 99)	3 (2 to 4)	3 (2.5 to 4)	0.46
Patient knowledge^d
Mean score (SD)	49.5 (23.41)	78.5 (23.15)	< 0.001
Score ≥ 75%, n(%)	16 (32.0)	36 (72.0)	< 0.001
Informed, patient-centered (IPC) decision on delivery admission^a	11/42 (26.1)	28/47 (59.6)	0.002
Secondary outcomes:
3Satisfaction
Amount of information about birth options
Much less / a little less than wanted	15 (30.0)	11 (22.0)	0.36
About right/ more than wanted	35 (70.0)	39 (78.0)
Clarity of information about birth options
Poor / Fair	14 (28.0)	4 (8.0)	0.02
Good / Very Good	27 (54.0)	30 (60.0)	0.02
Excellent	9 (18.0)	16 (32.0)
Balanced information about birth options
Strongly / slightly favors vaginal birth	15 (30.0)	14 (28.0)	0.07
Balanced	22 (44.0)	31 (62.0)	0.07
Slightly / strongly favors repeat cesarean	13 (26.0)	5 (10.0)
Values
Know in advance the delivery date (1–11), mean (SD)	5.0 (3.87)	6.2 (3.44)	0.09
Avoid a cesarean delivery (1–11), mean (SD)	6.1 (3.66)	6.1 (3.89)	0.93
Little pain as possible during delivery (1–11), mean, (SD), n = 99	6.2 (3.12)	6.85 (2.64)	0.29
Return to usual activities quickly after birth (0–10), mean (SD)	7.9 (2.57)	7.7 (2.67)	0.65
Have a vaginal birth (0–10), mean (SD)	6.0 (3.56)	5.7 (3.56)	0.69

^a N = 89 participants
^bThe Shared Decision Making Process Score assessed the clinician explaining birth options, including reasons for TOLAC and planned repeat cesarean delivery, and eliciting patient desires about mode of delivery
^cRespondents received 1 point for each of the following responses: discussed pros = some or a lot, discussed cons = some or a lot, asked preference = yes, and choices explained = yes
^dKnowledge assessed women’s knowledge of postoperative recovery, probability of repeat cesarean after TOLAC, and risk and implications of uterine rupture
⁴P-value compares routine care vs. patient decision aid groups (chi-square for categorical variables and Student’s T-test for continuous variables)

ISSN: 1471-2393