DECISION AID TOOLS IN OBSTETRIC CARE: A SYSTEMATIC LITERATURE REVIEW

Support for a model of shared medical decision making, in which clinicians and women openly discuss the risks and benefits of their options, reveal their preferences and jointly make a decision, is a growing expectation in obstetric care. Selection of the most effective decision support tools to assist in these important decision encounters will be paramount for a genuine shift from paternalism to partnership in health care. Different types of decision aid tools have focused on improving knowledge as well as minimizing anxiety and decreasing decisional conflict, while aiming to clarify values, improve patient satisfaction, promote active participation in decision making and facilitate the counseling task of health professionals.

The objective of this study was to conduct a systematic literature review to evaluate the effectiveness of different decision aid tools on knowledge, anxiety, decisional conflict, final choice and final outcome, in the specific context of pregnancy and birth.

We searched electronic databases in English from 2000 to 2015 on MEDLINE, Cochrane, DARE, CINAHL, EMBASE with key words “Obstetrics”, “Computer Based Decision Making”, “Decision Making Aids”, “Health Education”, “Informed Consent”, “Patient-Centered. At the end of review process, we found eleven studies which were met the inclusion criteria.

All decision aid tools were facilitated significant increases in knowledge about obstetric care such as birth type. The Computer-based Information Tool, the Decision Analysis Tools, Individual Counseling and Group Counseling intervention presented significant results in reducing anxiety levels and decisional conflict. The Decision Analysis Tool was the only tool that presented evidence of an impact on the final choice and final outcome. Decision aid tools can assist health care professionals to provide information and counseling about choices thought obstetric care. The choice of a specific tool should depend on resources available to support their use as well as the specific decisions being faced by women, their health care setting and providers. Although there is evidence that decision aid tools are safe and effective, studies are needed to identify effective strategies for their implementation into diverse clinical obstetric environments.