Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology: A Systematic Review and Meta-analysis
Obstet Gynecol 2020:135:444–51
Patients make important medical decisions, usually without the benefit of extensive knowledge, and they rely on their communications with their doctors and nurses to do so. Shared decision making describes one model for this communication that is dialogue in which the patient's values and wishes are the basis of decisions for which she understands the possible interventions and their risks and benefits. In this month's issue of Obstetrics & Gynecology, Poprzeczny et al1 (see page 444) report a systematic review and meta-analysis of 35 randomized controlled trials of the use of decision aids to support shared decision making in women's health.
The authors conclude that the use of patient decision aids reduced decisional conflict somewhat, which was their primary outcome. Decisional conflict describes a “patient's uncertainty about a decision”1 as well as her ability to make a personal value-based decision. Of their secondary outcomes, patient decision aids showed a moderate improvement in patient knowledge but no difference in patient anxiety or patient satisfaction compared with control groups.
Although their research could not report cost effectiveness nor the effectiveness of these tools in low-resource settings owing to limited information in the identified studies, it does support the use of patient decision aids in shared decision making. How to implement these? One resource to consider is the catalog of patient decision aids for a broad variety of health topics at the Ottawa Hospital Research Institute,2 which includes a list of identified aids and an evaluation of their quality.
This study demonstrates the utility of these tools and offers up a working definition of “shared decision making.”
Nancy C. Chescheir, MD
University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
Factors Influencing Women's Perceptions of Shared Decision Making During Labor and Delivery: Results From a Large-Scale Cohort Study of First Childbirth
Patient Educ Couns 2018;101:1130–6
A woman's ability to control how she brings her child into this world may be empowering. That woman's sense of involvement in the shared decision-making process regarding her labor is integral in establishing both a trusting patient–physician relationship and a loving mother–baby relationship.
Attanasio et al1 studied 3,006 women in Pennsylvania over 2 years who gave birth to their first child to determine reporting of shared decision making among cohort subsets. They conclude that women who underwent labor induction, instrumental vaginal delivery, or cesarean delivery were less likely to report experience with shared decision making during childbirth than women who underwent spontaneous delivery. They found that women who were black and did not have a college degree or private insurance were less likely to report shared decision making. Women who were black and underwent a cesarean delivery were particularly unlikely to report shared decision making.
Although the study comments on how likely a subset of the cohort is to report a sense of shared decision making, it would be valuable to determine the relation between a patient's sense of shared decision making and overall satisfaction with her labor.
Annam Abbasi, MD
The George Washington University Hospital, Washington, DC
Association of Emotional Intelligence with Malpractice Claims: A Review
JAMA Surg 2019;154:250–6
In conjunction with shared decision making, the patient–physician relationship is a fundamental part of the successful practice of medicine. There is growing evidence that this relationship largely influences whether a patient pursues a medical–legal case or not.
According to a study by Shouhed et al,1 emotional intelligence may play a large role in whether or not a physician is sued. Emotional intelligence is defined as an individual's ability to monitor and regulate his or her emotions as well as the emotions of others, and it can be objectively measured through several quantitative tests. In this review, surgical specialty, middle age (40–50 years old), and male sex were more likely to be associated with a malpractice claim. Of these factors, sex has been shown to affect emotional intelligence score, with women often scoring higher than men. Some studies have shown a positive association between higher emotional intelligence scores and patient satisfaction, and other studies have shown that physicians with low patient satisfaction ratings have a significantly increased risk of malpractice suits.
The authors admit that a limitation of this review is a lack of studies that directly examine the association between physician emotional intelligence and malpractice claims, as well as a lack of consensus about whether emotional intelligence is an inherent trait or whether it can be improved on. However, given the growing interest in emotional intelligence and the role it plays as a predictive tool of achievement in other fields, such as finance and sports, emotional intelligence could be a valuable assessment in medicine.
Julie Watters, DO
Robert E. Bush Naval Hospital, Twentynine Palms, California
Providing Advice to Parents for Women at Acutely High Risk of Periviable Delivery
Obstet Gynecol 2010;115:904–9
Preterm labor in the periviable period is often unexpected and stressful. Establishing rapport with patients in this acute time is critical to effectively providing a breadth of information with an uncertain prognosis. The emotional intelligence of obstetricians is tested in these situations—they must regulate their own emotions in response to their patients to reach a shared and informed decision.
A qualitative study by Grobman et al1 investigated how obstetricians, nurses, and families approach and respond to the threat of extreme premature birth. The authors aimed to elucidate preferred approaches and pitfalls in counseling and differences of patient and physician preferences in such situations. Interviews with 40 women at risk for preterm birth between 21 and 25 weeks of gestation were analyzed for themes. Parents stressed the importance of receiving clear information as quickly as possible for them to make necessary decisions. Patients with limited preexisting knowledge appreciated restricted use of jargon, supplemental reading, and acknowledging hope. On the other hand, physicians feared providing false hope and felt the clinical picture around preterm birth evolved so quickly that provided materials soon became irrelevant. The limitations of the study included a single urban center with small sample size. The authors emphasize the importance of communication and empathy for patients enduring this stressful event and offer recommendations to strengthen the patient–physician relationship.
Tesia Kim, MD, MSEd
Beth Israel Deaconess Medical Center, Boston, MA
1. Grobman WA, Kavanaugh K, Moro T, DeRegnier RA, Savage T. Providing advice to patients for women at acutely high risk of periviable delivery. Obstet Gynecol 2010:904–9.