535: Patient decision aid for trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery(PRCD)

Abstract

Given few eligible women attempt a trial of labor after cesarean (TOLAC), evidence-based tools are needed to guide patient-provider shared decision-making (SDM). Our objective was to assess the impact of a web-based patient decision aid (pDA) intervention on patient decision-making of TOLAC versus planned repeat cesarean delivery (PRCD). The Birth Decision Aid Study (B-READY) was a quasi-experimental study conducted between 7/2018 to 7/2019 with sequential enrollment of pregnant women (singleton pregnancies 19/0 to 36/6 weeks, ≤2 prior cesareans, and no contraindication to TOLAC) into standard care and pDA intervention groups. The pDA group viewed the web-based Healthwise® “Pregnancy: Birth Options After Cesarean” program, attended a birth options discussion visit with their obstetric provider, and completed an online SDM assessment. The standard care group received routine prenatal counseling on birth options and completed the SDM assessment. Outcomes were patient involvement in decision-making by the SDM Process Score, knowledge, satisfaction, and patient leaning towards mode of delivery. Eighty-five women enrolled in the study, 42 (49%) in the intervention pDA group and 43 (51%) in the standard care group. Groups did not differ by socio-demographics, obstetric provider type, number of prior cesareans, or desire for future pregnancies. Women in both groups reported similar involvement in SDM about mode of delivery (Table). The pDA group had greater knowledge (mean test score: 78% vs. 50%; p< 0.001) and better satisfaction with clarity of the information provided (p< 0.01) versus the standard care group. The pDA group was more likely to lean towards choosing PRCD than TOLAC (50% vs. 35%; p=0.03) and expressed greater readiness to decide about mode of delivery (95% vs. 81%; p=0.04) versus the standard care group. 97% of pDA users found it useful and would recommend it to other women. A web-based birth options pDA demonstrated increased patient involvement in decision-making about mode of delivery, including patient knowledge, satisfaction, and readiness to decide.View Large Image Figure ViewerDownload Hi-res image Download (PPT)