Implementing an Internet‐based Decision Aid in Ethnically Diverse Prenatal Care Settings: Reducing Disparities through Shared Decision Making about Birth after Cesarean

摘要

Introduction Decision aids have been recommended for value‐sensitive health care decisions such as mode of birth after previous cesarean. However, effective strategies for widespread clinical implementation of decision aids, to reduce disparities and improve shared decision‐making experiences, are currently lacking. The purpose of this study was to evaluate the feasibility and acceptability of implementing an interactive internet‐based decision aid to support women making shared decisions about birth after previous cesarean in urban and racially and ethnically diverse outpatient clinic settings. Methods A before‐and‐after study design was used to assess the feasibility and acceptability of implementing an internet‐based decision aid designed to prepare women and providers for shared decision making about birth after cesarean. Changes in women's knowledge about their birth options and levels of decisional conflict about mode of birth were measured before and after access to the decision aid. Preferences for mode of birth and actual birth outcomes were compared to assess alignment with birth mode choice. Women who indicated they used the decision aid during pregnancy provided ratings on acceptability of content, features, and functions. Results Participants included 68 pregnant women (mean age 29.3 years) from ethno‐racially diverse backgrounds (black, 46.2%; Hispanic, 35.4%; white, 13.8%; Asian or other, 4.6%) who were eligible to choose between planned vaginal birth after cesarean (VBAC) and planned repeat cesarean. Knowledge of birth options scores increased by 2.58 points out of 15 ( P .001, d = 0.87) and decisional conflict scores reduced by 0.45 points out of 5 points ( P .001, d = 0.69). Forty‐four women (65.9%) attempted VBAC, of whom, 29 (65.7%) succeeded. Participants who used the decision aid during pregnancy rated its content, features, and functions as good or excellent and indicated they would recommend the decision aid to other women. Discussion It is potentially feasible to implement interactive internet‐based decision aids within ethnically and racially diverse prenatal care settings to address disparities in decision preparation. Strategies to improve timely decision aid access and promote consistent utilization of decision support for all women are needed. Seamless integration into workflow, including use of the electronic health record, is an important next step for future dissemination and implementation research.