Shared decision aids in pregnancy care: A scoping review
Abstract
Background Shared decision making in pregnancy, labour, and birth is vital to woman-centred care and despite strong evidence for the effectiveness of shared decision making in pregnancy care, practical uptake has been slow.Design and aim This scoping review aimed to identify and describe effective and appropriate shared decision aids designed to be provided to women in the antenatal period to assist them in making informed decisions for both pregnancy and birth. Two questions guided the enquiry: (i) what shared decision aids for pregnancy and perinatal care are of appropriate quality and feasibility for application in Australia? (ii) which of these decision aids have been shown to be effective and appropriate for Aboriginal and Torres Strait Islander peoples, culturally diverse women, or those with low literacy?Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) was used to conduct the review. Five key databases and selected grey literature sources were examined. English language evidence from Australia, Europe, Canada, United Kingdom, New Zealand, and United States of America produced from 2009 was eligible for inclusion, checked against apriori inclusion criteria, and assessed for quality and usability using the International Patient Decision Aid Standards.Results From a total of 5,209 search results, 35 sources of evidence reporting on 27 decision aids were included following title/abstract and full-text review. Most of the decision aids concerned decisions around birth (52%, n = 14) or antenatal screening 37% (n = 10). The quality of the decision aids was moderate to high, with most communicating risks, benefits, and choice pathways via a mix of Likert-style scales, quizzes, and pictures or graphs. Use of decision aids resulted in significant reductions in decisional conflict and increased knowledge. The format of decision aids appeared to have no effect on these outcomes, indicating that paper-based are as effective as video- or audio-based decision aids. Eleven decision aids were suitable for low literacy or low health literacy women, and six were either developed for culturally diverse groups or have been translated into other languages. No decision aids found were specific to Aboriginal and Torres Strait Islander peoples.Conclusions and implications for practice The 27 decision aids are readily adoptable into westernised healthcare settings and can be used by midwives or multidisciplinary teams in conjunction with women. Decision aids are designed to support women, and families to arrive at informed choices and supplement the decision-making process rather than to replace consumer-healthcare professional interaction. If given before an appointment, high quality decision aids can increase a woman's familiarity with medical terminology, options for care, and an insight into personal values, thereby decreasing decisional conflict and increasing knowledge.
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Government organisations are often interested in the availability and applicability of tools to support health interventions, such as shared decision aids for pregnancy care.
“Topics where scoping reviews are necessary abound—for example, government organisations are often interested in the availability and applicability of tools to support health interventions, such as shared decision aids for pregnancy care [30].”
From Scoping reviews: reinforcing and advancing the methodology and application (2021) · cites this paper as [30]
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Scoping reviews: reinforcing and advancing the methodology and application
Peters, M. D. J., Marnie, C., Colquhoun, H., Garritty, C. M., Hempel, S., Horsley, T., Langlois, E. V., Lillie, E., O’Brien, K. K., Tunçalp, Ӧ., et al. (2021) · Systematic Reviews · doi:10.1186/s13643-021-01821-3 · Cited by 887 · see citing works
Self-citation
- Authors
- Kennedy, K., Adelson, P., Fleet, J., Steen, M., McKellar, L., Eckert, M., & Peters, M. D. J.
- Affiliations
- University of South Australia (AU)
- Corresponding author
- Kennedy, Kate
- ORCID
- Venue
- Midwifery
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 81
- Pages
- 102589
- ISSN
- 0266-6138 (ISSN-L)
- OpenAlex
- W2989853337
- Cited by
- 50
- References
- 43
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 16 · 2023: 11 · 2022: 5 · 2021: 6 · 2020: 2
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Midwifery (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion)
- Funders
- NSW Ministry of Health
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- shared decision-making, decision aids, obstetric care, prenatal care, prenatal screening, decisional conflict, health literacy, Aboriginal and Torres Strait Islander peoples, informed choice, midwives, Australia, New Zealand, Canada, United States, United Kingdom, Europe, South America
- MeSH terms
- Decision Making, Shared, Australian Aboriginal and Torres Strait Islander Peoples, Australia, Decision Support Techniques, Ethnicity, Female, Humans, Pregnancy, Prenatal Care, Perinatal Care, Population Groups, Culturally Competent Care
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