Patient decision aids can be used to support pregnant women engaging in shared decisions, but little is known about their effects in obstetrics. The authors aimed to evaluate the effects of patient decision aids designed for pregnant women on clinical and psychosocial outcomes.
Systematic review. Data on all outcomes were extracted and summarised. All studies were critically appraised for potential sources of bias and, when possible to obtain, the reported decision aids were evaluated. Meta-analysis was not possible due to the heterogeneity of outcomes in primary studies and the small number of studies.
Electronic searches were performed using Medline, Embase, the Cochrane Library and Medion databases from inception until December 2010. Reference lists of all included articles were also examined and key experts contacted.
Eligibility criteria for selecting studies
Eligibility criteria included randomised controlled trials, which reported on patient decision aids for women facing any treatment decision in pregnancy published in English. Studies evaluating health education material that did not address women's values and preferences were excluded.
Patient decision aids have been developed for decisions about prenatal testing, vaginal birth after Caesarean section, external cephalic version and labour analgesia. Use of decision aids is associated with a number of positive effects including reduced anxiety, lower decisional conflict, improved knowledge, improved satisfaction and increased perception of having made an informed choice.
Patient decision aids have the potential to improve obstetric care. However, currently the evidence base is limited by the small number of studies, the quality of the studies and because they involved heterogeneous decision aids, patient groups and outcomes.
Engaging pregnant women in shared decision making has become a priority for maternity care but remains a challenge for many health professionals.
Patient decision aids can be used to facilitate patient involvement in decision making and improve clinical practice. They are interventions, which provide information about options and outcomes as well as clarifying the user's values. However, little is known about their effects in obstetrics.
We aimed to evaluate the effects of decision aids designed for pregnant women on clinical and psychosocial outcomes.
Eleven randomised controlled trials were identified investigating the effects of patient decision aids on a range of outcomes.
Use of patient decision aids was associated with a number of positive effects including: reduced anxiety (three studies), improved knowledge (seven studies), improved satisfaction (two studies), increased perception of having made an informed choice (one study) and lower decisional conflict (five studies).
Further research is needed to expand this limited evidence base and to develop better outcomes to assess the quality of decision making.
Strengths and limitations of this study
This is the first systematic review of patient decision aids in obstetrics and provides a comprehensive and critical review of the available evidence.
A number of potential benefits supporting the use of decision aids in clinical practice were identified.
The limited evidence base was demonstrated aiming to stimulate the development of further decision aids and research into evaluation and implementation of them.
There is need to be cautious in interpreting the potential benefit of decision aids in routine practice in pregnancy due to the limitations of the small number of randomised controlled trials and the inconsistencies in their results.
Meta-analysis could not be performed due to the small sample size and heterogeneity of primary outcomes chosen.