Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. A decision aid tool significantly helped resolve decision conflict in patients contemplating the use of epidural anesthesia during labour.

Evidence Rating Level: 1 (Excellent)

In Japan, analgesic use in delivery of babies is low compared to other countries, with only 6.2% of women receiving epidural anesthesia in 2016. This could stem from a variety of reasons, such as few hospitals where epidurals can be provided (15.0%), cultural beliefs on labour pain, and lack of information provided to pregnant women. To address the latter cause, decision aids (DAs) have been proposed as a potential tool to educate patients on different treatment options available to them. The current study was a non-randomized controlled trial analyzing the effectiveness of DAs on influencing a pregnant woman’s choice to use epidural anesthesia or not. The control group of 150 women was recruited first, where patients were given a standard 10-page pamphlet at their 34-week gestation visit, outlining the benefits and potential consequences. The DA group was recruited next, comprising of 149 women: The 22-page DA pamphlet included more information on the options, presented a comparison in tables, and provided tools to aid in values clarification and the decision making process. All participants had low-risk, singleton pregnancies. The primary outcome measured was a change in the mean Decision Conflict Scale score, a self-report questionnaire that measures a participant’s uncertainty surrounding a decision, with scores ranging from 0 to 100. This questionnaire was provided before and after the pamphlets were read through. The results showed that the DA group had significantly lower DCS scores than the control group (DCS -8.41, SD 8.79 in the DA group; DCS -1.69, SD 5.91 in the control; p < 0.001). Furthermore, the percentage of undecided women decreased significantly in the DA group, from 30.2% to 6.1% (p < 0.001), whereas the percentage was not different in the control group (40.7% to 38.9%). Study findings demonstrated that a DA for epidural anesthesia can help alleviate indecisiveness in patients, contributing to better informed and shared decision making.

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