Patient decision aid for trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery: a quasi-experimental pre-post study

Kartik K Venkatesh, Suzanne Brodney, Michael J Barry, Jamie Jackson, Kiira M Lyons, Asha N Talati, Thomas S Ivester, Maria C Munoz, John M Thorp, Wanda K Nicholson, Kartik K Venkatesh, Suzanne Brodney, Michael J Barry, Jamie Jackson, Kiira M Lyons, Asha N Talati, Thomas S Ivester, Maria C Munoz, John M Thorp, Wanda K Nicholson

Abstract

Objective: To assess the impact of a web-based decision aid on patient-centered decision making outcomes among women considering a trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery.

Methods: The Birth Decision Aid Study (B-READY) was a quasi-experimental pre-post study of two sequential cohorts. From June 18, 2018 to July 31, 2019, 50 women were enrolled in routine care, followed by 50 women who were enrolled in the decision aid group. Inclusion criteria were singleton pregnancies between 19/0 to 36/6 weeks, ≤2 prior cesareans, and no contraindications to TOLAC. The decision aid group viewed the online Healthwise® "Pregnancy: Birth Options After Cesarean" program. Both groups received the same birth options counseling and completed the same online assessment. Primary patient-centered outcomes were knowledge about birth options and shared decision making at online assessment, and informed, patient-centered decision making about her preferred mode of delivery at delivery admission.

Results: Among 100 women participated in this study (50 per group), the mean gestational age at enrollment was 31 weeks, and 71% or 63/89 women who consented to delivery data abstraction had a cesarean delivery. Women in the patient decision aid group gained more knowledge (defined as score ≥ 75%) about birth options compared to those in the routine care group (72% vs. 32%; adjusted odds ratio, AOR: 6.15 [95% CI: 2.34 to 16.14]), and were more likely to make an informed, patient-centered decision (60% vs. 26%; AOR: 3.30 [95% CI: 1.20 to 9.04]. Women in both groups reported similar involvement in shared decision making, as well as satisfaction and values. More than 90% of decision aid users reported it was a useful tool and would recommend it to other TOLAC-eligible women.

Conclusions: A web-based birth options patient-centered decision aid for TOLAC eligible women can be integrated into prenatal Telehealth and may improve the quality of decision making about mode of delivery.

Trial registration: The study was registered with ClinincalTrials.gov and the ID# was NCT04053413 . Registered 12 August 2019 - Retrospectively registered.

Keywords: Cesarean delivery; Decision aid; Shared decision making; Telehealth; Trial of labor after cesarean; Vaginal birth after cesarean.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Conceptual diagram of shared decision making for TOLAC counseling. Footnote: This figure is adapted from a shared decision making conceptual framework for medical decision making as outlined by Sepucha et al. 2009 [31]. Abbreviations: TOLAC = trial of labor after cesarean, VBAC = vaginal birth after cesarean, PRCD = planned repeat cesarean delivery, and RCD = repeat cesarean delivery
Fig. 2
Fig. 2
Flowchart of study participants

References

    1. Curtin S, Gregory KD, Korst LM, Uddin SF. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013. Natl Vital Stat Rep. 2015;64(4):1–13.
    1. Grobman W, Lai Y, Landon MB, Spong CY, Rouse DJ, Varner MW, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network The change in the rate of vaginal birth after caesarean section. Pediatr Perinat Epidemiol. 2011;25(1):37–43. doi: 10.1111/j.1365-3016.2010.01169.x.
    1. Kirk E, Doyle KA, Leigh J, Garrard ML. Vaginal birth after cesarean or repeat cesarean section: medical risks or social realities? Am J Obstet Gynecol. 1990;162(6):1398–1403. doi: 10.1016/0002-9378(90)90898-H.
    1. McClain C. The making of a medical tradition: vaginal birth after cesarean. Soc Sci Med. 1990;31(2):203–210. doi: 10.1016/0277-9536(90)90062-W.
    1. McClain C. Why women choose trial of labor or repeat cesarean section. J Fam Pract. 1985;21(3):210–216.
    1. Landon M, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM, Gabbe SG, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581–2589. doi: 10.1056/NEJMoa040405.
    1. Metz T, Stoddard GJ, Henry E, Jackson M, Holmgren C, Esplin S. How do good candidates for trial of labor after cesarean (TOLAC) who undergo elective repeat cesarean differ from those who choose TOLAC? Am J Obstet Gynecol. 2013;208(6):e1–e6. doi: 10.1016/j.ajog.2013.02.011.
    1. Fowler FJ, Gerstein BS, Barry MJ. How patient centered are medical decisions?: results of a national survey. JAMA Intern Med. 2013;173(13):1215–1221. doi: 10.1001/jamainternmed.2013.6172.
    1. Cr B, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. J Am Med Assoc. 1999;282(24):2313–2320. doi: 10.1001/jama.282.24.2313.
    1. Little M, Lyerly AD, Mitchell LM, Armstrong EM, Harris LH, Kukla R, Kuppermann M. Mode of delivery: toward responsible inclusion of patient preferences. Obstet Gynecol. 2008;112(4):913–918. doi: 10.1097/AOG.0b013e3181888fd8.
    1. Gagliardi A, Dunn S, Foster A, Grace SL, Green CR, Khanlou N, Miller FA, Stewart DE, Vigod S, Wright FC. How is patient-centred care addressed in women's health? A theoretical rapid review. BMJ Open. 2019;9(2):e026121. doi: 10.1136/bmjopen-2018-026121.
    1. Prabhu M, McQuaid-Hanson E, Hopp S, Burns SM, Leffert LR, Landau R, Lauffenburger JC, Choudhry NK, Kaimal A, Bateman BT. A shared decision-making intervention to guide opioid prescribing after cesarean delivery. Obstertr Gynecol. 2017;130(1):42–46. doi: 10.1097/AOG.0000000000002094.
    1. Vilkins A, Sahara M, Till SR, Ceci C, Howard R, Griffith KC, Waljee JF, Lim CS, Skinner BD, Clauw DJ, Brummett CM, As-Sanie S. Effects of shared decision making on opioid prescribing after hysterectomy. Obstet Gynecol. 2019;134(4):823–833. doi: 10.1097/AOG.0000000000003468.
    1. American College of Obstetricians and Gynecologists ACOG Practice Bulletin No. 205: vaginal birth after cesarean delivery. Obstertr Gynecol. 2019;133(2):e110–ee27. doi: 10.1097/AOG.0000000000003078.
    1. Kaimal AJ, Grobman WA, Bryant A, Blat C, Bacchetti P, Gonzalez J, Thiet MP, Bermingham Y, Kuppermann M. The association of patient preferences and attitudes with trial of labor after cesarean. J Perinatol. 2019;39(10):1340–8.
    1. Kaimal AJ, Grobman WA, Bryant AS, Norrell L, Bermingham Y, Altshuler A, Thiet MP, Gonzalez J, Bacchetti P, Moghadassi M, Kuppermann M. Women's preferences regarding the processes and outcomes of trial of labor after cesarean and elective repeat cesarean delivery. J Womens Health (Larchmt). 2019;28(8):1143–52.
    1. Moffat M, Bell JS, Porter MA, Lawton S, Hundley V, Danielian P, Bhattacharya S. Decision making about mode of delivery among pregnant women who have previously had a caesarean section: a qualitative study. Brit J Obstetr Gynecol. 2007;114(1):86–93. doi: 10.1111/j.1471-0528.2006.01154.x.
    1. Biraboneye S, Ogutu O, van Roosmalen J, Wanjala S, Lubano K, Kinuthia J. Trial of labour or elective repeat caesarean delivery:are women making an informed decision at Kenyatta national hospital? BMC Pregnancy Childbirth. 2017;17(1):260. doi: 10.1186/s12884-017-1440-3.
    1. Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4(4):CD001431. 10.1002/14651858.CD001431.pub5.
    1. Poprzeczny AJ, Stocking K, Showell M, Duffy JMN. Patient decision aids to facilitate shared decision making in obstetrics and gynecology: a systematic review and meta-analysis. Obstet Gynecol. 2020;135(2):444–51.
    1. Sepucha K, Abhyankar P, Hoffman AS, Bekker HL, LeBlanc A, Levin CA, Ropka M, Shaffer VA, Sheridan SL, Stacey D, Stalmeier P, Vo H, Wills CE, Thomson R. Standards for UNiversal reporting of patient decision aid evaluation studies: the development of SUNDAE checklist. BMJ Qual Saf. 2018;27(5):380–388. doi: 10.1136/bmjqs-2017-006986.
    1. Kaimal A, Kuppermann M. Understanding risk, patient and provider preferences, and obstetrical decision making: approach to delivery after cesarean. Semin Perinatol. 2010;34(5):331–336. doi: 10.1053/j.semperi.2010.05.006.
    1. Wang C, Liu TT, Car J, Zuckerman B. Design, adoption, implementation, scalability, and sustainability of Telehealth programs. Pediatr Clin N Am. 2020;67(4):675–682. doi: 10.1016/j.pcl.2020.04.011.
    1. Lundgren I, Smith V, Nilsson C, Vehvilainen-Julkunen K, Nicoletti J, Devane D, Bernloehr A, van Limbeek E, Lalor J, Begley C. Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review. BMC Pregnancy Childbirth. 2015;15:16. doi: 10.1186/s12884-015-0441-3.
    1. Montgomery A, Emmett CL, Fahey T, Jones C, Ricketts I, Patel RR, Peters TJ, Murphy DJ, DiAMOND Study Group Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial. Brit J Obstetr Gynecol. 2007;334(7607):1305.
    1. Eden K, Perrin NA, Vesco KK, Guise JM. A randomized comparative trial of two decision tools for pregnant women with prior cesareans. J Obstet Gynecol Neonatal Nurs. 2014;43(5):568–579. doi: 10.1111/1552-6909.12485.
    1. Kuppermann M, Kaimal AJ, Blat C, et al. Effect of a patient-centered decision support tool on rates of trial of labor after previous cesarean delivery: the PROCEED randomized clinical trial. J Am Med Assoc. 2020;323(21):2151–2159. doi: 10.1001/jama.2020.5952.
    1. Swamy G, Grotegut CA. Can a structured, electronic approach to shared decision-making increase attempted trial of labor? J Am Med Assoc. 2020;323(21):2145–2146. doi: 10.1001/jama.2020.5947.
    1. Chen S, Hutchinson AM, Nagle C, Bucknall TK. Women's decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study. BMC Pregnancy Childbirth. 2018;18(1):31. doi: 10.1186/s12884-018-1661-0.
    1. DeNicola N, Grossman D, Marko K, Sonalkar S, Butler Tobah YS, Ganju N, Witkop CT, Henderson JT, Butler JL, Lowery C. Telehealth interventions to improve obstetric and gynecologic health outcomes: a systematic review. Obstet Gynecol. 2020;135(2):371–382. doi: 10.1097/AOG.0000000000003646.
    1. Sepucha K, Mulley AG., Jr A perspective on the patient's role in treatment decisions. Med Care Res Rev. 2009;66(S1):53S–74S. doi: 10.1177/1077558708325511.
    1. Harris A, McGregor JC, Perencevich EN, et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc. 2006;13(1):16–23. doi: 10.1197/jamia.M1749.
    1. Billingham S, Whitehead A, Julious S. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom clinical research network database. BMC Med Res Methadol. 2013;13:104. doi: 10.1186/1471-2288-13-104.
    1. Grobman W, Lai Y, Landon MB, Spong CY, Leveno KJ, Rouse DJ, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, O'Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM, National Institute of Child Health and Human Development (NICHD) maternal-fetal medicine units network (MFMU) Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstetr Gynecol. 2007;109:806–812. doi: 10.1097/01.AOG.0000259312.36053.02.
    1. Arozullah A, Yarnold PR, Bennett CL, Soltysik RC, Wolf MS, Ferreira RM, Lee SY, Costello S, Shakir A, Denwood C, Bryant FB, Davis T. Development and validation of a short-form, rapid estimate of adult literacy in medicine. Med Care. 2007;45(11):1026–1033. doi: 10.1097/MLR.0b013e3180616c1b.
    1. Sepucha K, Atlas SJ, Chang Y, Freiberg A, Malchau H, Mangla M, Rubash H, Simmons LH, Cha T. Informed, patient-centered decisions associated with better health outcomes in orthopedics: prospective cohort study. Med Decis Mak. 2018;38(8):1018–1026. doi: 10.1177/0272989X18801308.
    1. Fowler FJ, Gallagher PM, Bynum JP, Barry MJ, Lucas FL, Skinner JS. Decision-making process reported by Medicare patients who had coronary artery stenting or surgery for prostate cancer. J Gen Intern Med. 2012;27(8):911–916. doi: 10.1007/s11606-012-2009-5.
    1. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49(5):651–661. doi: 10.1016/S0277-9536(99)00145-8.
    1. Sepucha KR, Fowler FJ Jr, Mulley AG Jr. Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff (Millwood). 2004;Suppl Variation:VAR54–62. 10.1377/hlthaff.var.54.
    1. Schoorel E, Vankan E, Scheepers HC, Augustijn BC, Dirksen CD, de Koning M, van Kuijk SM, Kwee A, Melman S, Nijhuis JG, Aardenburg R, de Boer K, Hasaart TH, Mol BW, Nieuwenhuijze M, van Pampus MG, van Roosmalen J, Roumen FJ, de Vries R, Wouters MG, van der Weijden T, Hermens RP. Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid. Brit J Obstetr Gynecol. 2014;121(2):202–209. doi: 10.1111/1471-0528.12516.
    1. Shorten A, Chamberlain M, Shorten B, Kariminia A. Making choices for childbirth: development and testing of a decision-aid for women who have experienced previous caesarean. Patient Educ Couns. 2004;52(3):307–313. doi: 10.1016/S0738-3991(03)00106-X.
    1. Frost J, Shaw A, Montgomery A, Murphy DJ. Women's views on the use of decision aids for decision making about the method of delivery following a previous caesarean section: qualitative interview study. Brit J Obstetr Gynecol. 2009;116(7):896–905. doi: 10.1111/j.1471-0528.2009.02120.x.
    1. Shorten A, Shorten B, Keogh J, West S, Morris J. Making choices for childbirth: a randomized controlled trial of a decision-aid for informed birth after cesarean. Birth. 2005;32(4):252–261. doi: 10.1111/j.0730-7659.2005.00383.x.
    1. Scaffidi R, Posmontier B, Bloch JR, Wittmann-Price R. The relationship between personal knowledge and decision self-efficacy in choosing trial of labor after cesarean. J Midwifery Women’s Health. 2014;59(3):246–253. doi: 10.1111/jmwh.12173.
    1. Wu E, Kaimal AJ, Houston K, Yee LM, Nakagawa S, Kuppermann M. Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery. Am J Obstet Gynecol. 2014;210(5):440. doi: 10.1016/j.ajog.2013.11.021.
    1. Yee L, Kaimal AJ, Houston KA, Wu E, Thiet MP, Nakagawa S, Caughey AB, Firouzian A, Kuppermann M. Mode of delivery preferences in a diverse population of pregnant women. Am J Obstet Gynecol. 2015;212(3):377. doi: 10.1016/j.ajog.2014.10.029.
    1. Bartolo S, Goffinet F, Blondel B, Deneux-Tharaux C. Why women with previous caesarean and eligible for a trial of labour have an elective repeat caesarean delivery? A national study in France. Brit J Obstetr Gynecol. 2016;123(10):1664–1673. doi: 10.1111/1471-0528.14056.
    1. Nakamura-Pereira M, Esteves-Pereira AP, Gama SGN, Leal M. Elective repeat cesarean delivery in women eligible for trial of labor in Brazil. Int J Obstetr Gynecol. 2018;143(3):351–359. doi: 10.1002/ijgo.12660.
    1. Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section - an online survey investigating women's preferences in Western Switzerland. Midwifery. 2017;50:219–227. doi: 10.1016/j.midw.2017.04.005.
    1. Lundgren I, Healy P, Carroll M, Begley C, Matterne A, Gross MM, Grylka-Baeschlin S, Nicoletti J, Morano S, Nilsson C, Lalor J. Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates. BMC Pregnancy Childbirth. 2016;16(1):350. doi: 10.1186/s12884-016-1144-0.
    1. Gardner K, Henry A, Thou S, Davis G, Miller T. Improving VBAC rates: the combined impact of two management strategies. Austr N Z J Obstetr Gynecol. 2014;54(4):327–332. doi: 10.1111/ajo.12229.
    1. Emmett C, Shaw AR, Montgomery AA, Murphy DJ, DiAMOND study group Women’s experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks. Brit J Obstetr Gynecol. 2006;113(12):1438–1445. doi: 10.1111/j.1471-0528.2006.01112.x.
    1. Phipps M, Venkatesh KK, Ware C, Lightfoot M, Raker C, Rodriguez P. Project ESCUCHE: A Spanish-language radio-based intervention to increase science literacy. Rhode Island Med J. 2018;101(10):41–45.
    1. Walker D, Hefner J, Fareed N, Huerta T, McAlearney A. Exploring the digital divide: age and race disparities in use of an inpatient portal. Telemed J E Health. 2020;26(5):603–613. doi: 10.1089/tmj.2019.0065.
    1. Roberts R, Deutchman M, King VJ, Fryer GE, Miyoshi TJ. Changing policies on vaginal birth after cesarean: impact on access. Birth. 2007;34(4):316–322. doi: 10.1111/j.1523-536X.2007.00190.x.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever