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Are women having a cesarean delivery engaged in shared decision-making regarding post-cesarean analgesia? An exploratory survey study.
Abstract Number: S1A-4
Abstract Type: Original Research
Background: Shared decision making (SDM) involves both the patient and provider in sharing information to reach a consensus about preferred treatment and implementation.1 It involves combining evidence-based practice with the patient’s own preferences and values. Patient involvement in their health care decisions is widely recognized as important from an ethical, clinical, and public health perspective,2 but current literature regarding SDM in obstetrical anesthesia is limited. This study aimed to determine if women are being engaged in SDM regarding their post-cesarean delivery (CD) analgesia.
Methods: With institutional ethics approval, during a 6-month period, 79 women undergoing elective CD with spinal anesthesia were recruited. Research assistants met with participants the day following their CD and administered three brief questionnaires: a Control Preferences Scale (CPS) survey regarding the level of SDM they experienced for post-CD analgesia (CPS1), a CPS survey regarding the type of care they would like to receive in the future (CPS2), and the Assessment of Empathic Communication in Medical Interviews (AECMI). We also determined if patients would prefer to be involved in SDM in subsequent surgery.
Results: A total of 74 participants were included. The majority of patients (53%) described experiencing low levels of SDM regarding their post-CD analgesia management, but indicated they would want SDM in the future (62%). The mean AECMI score was 54 +/- 10, out of a possible 63 points, suggesting that the anesthesia providers demonstrated reasonably high levels of empathy during the patient encounter. There were no statistically significant correlations found between responses on either CPS survey and AECMI scores (CPS1 R= -0.082, p=0.474; CPS2 R=0.074, p=0.517), education level (CPS1 R=0.061, p=0.591; CPS2 R=0.045 p=0.692), ethnicity (CPS1 R=-0.062, p=0.589; CPS2 R=0.092, p=0.422), or relationship status (CPS1 R=-0.007, p=0.953; CPS2 R=-0.133, p=0.243).
Conclusions: Study results indicate that although providers demonstrated empathy, patients did not feel they were engaged in SDM regarding post-CD analgesia. The degree of empathy demonstrated by the provider does not appear to correlate with the degree of SDM experienced by patients or their desire for SDM in the future; suggesting these as unrelated constructs. Future studies are need to determine ways to optimize SDM prior to CD.
1. Soc Sci Med. 1997;44(5):681-92.
2. BJA. 2002;89(6):863-72.