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Evaluation of a patient-centered analgesic counseling tool
Abstract Number: SAT-44
Abstract Type: Original Research
Background: The decision to use, or not use, neuraxial labor analgesia is a complex decision, with both maternal and fetal considerations. Patients have many concerns about neuraxial analgesia that may not be addressed in routine counseling. Physicians must ensure that patients understand the risks, benefits, and alternatives to neuraxial analgesia when obtaining informed consent. Our group developed a labor analgesic counseling tool to help guide women in their analgesic decision making. The objective of this study was to evaluate the impact of the counseling tool on analgesic counseling content.
Methods: The counseling tool content was developed through a review of the literature and qualitiative interviews with stakeholders. The tool was written at a low-literacy level (6th grade). Twenty anesthesiologists (10 resident physicians and 10 attending physicians) were recruited for participation. Participants were asked to provide analgesic counseling to a standardized patient who was admitted to L&D for labor. Participants were oriented to the counseling tool and at least one week after orientation, were asked to provide another analgesic counseling session. The counseling sessions were video recorded and the counseling content was scored using a previously developed scoring matrix (25 point total). A paired t-test was used to compare the counseling content prior to and following counseling tool orientation. Counseling content was compared between resident and attending anesthesiologists using a two-tailed t-test.
Results: The mean counseling tool score prior to counseling tool orientation was 13 ± 3. Following counseling tool orientation, the mean counseling tool score increased to 18 ± 5 (P = 0.002). There were no differences in counseling content between attending and resident physicians either prior to or following counseling tool orientation. The difference in means (residents compared to attendings) prior to counseling tool orientation was -2 (95% confidence interval [CI]: -5 to 1) and following counseling tool orientation was 2 (95% confidence interval [CI]: -5 to 8). Improvements were seen in discussion of why the interview was occurring (76% vs. 100%), analgesic options (29% vs. 88%), and in certain risks that are of concern to patients, such as paralysis (12% vs 76%).
Conclusions: The use of a low-literacy counseling tool increased the amount of information delivered during analgesic counseling. While there are no formal guidelines as to what information needs to be included in informed consent for labor analgesia, information about risks, benefits, and alternatives should be included. Inconsistent delivery of information may result in poor-quality decision-making, emphasizing the need for a more standardized process for informed consent. Future work should evaluate implementation of the counseling tool on patient knowledge and satisfaction with analgesic counseling, as well as the impact on use of neuraxial labor analgesia.