Shishido Eri, Osaka Wakako, Henna Ayame, Motomura Yuko, Horiuchi Shigeko
St. Luke's International University, Tokyo, Japan.
Keio University, Tokyo, Japan.
PLoS One. 2020 Nov 12;15(11):e0242351. doi: 10.1371/journal.pone.0242351. eCollection 2020.
Decision aids (DAs) are useful in providing information for decision-making on using epidural anesthesia during birth. To date, there has been little development of DAs for Japanese pregnant women. Herein, we investigated the effect of a DA on the decision of pregnant women whether to have epidural anesthesia or not for labor during vaginal delivery. The primary outcome was changes in mean decision conflict score.
In this non-randomized controlled trial, 300 low-risk pregnant women in an urban hospital were recruited by purposive sampling and assigned to 2 groups: DA (intervention) and pamphlet (control) groups. Control enrollment was started first (until 150 women), followed by intervention enrollment (150 women). Pre-test and post-test scores were evaluated using the Decision Conflict Scale (DCS) for primary outcome, knowledge of epidural anesthesia and satisfaction with decision making for secondary outcomes, and decision of anesthesia usage (i.e., with epidural anesthesia, without epidural anesthesia, or undecided).
Women in the DA group (n = 149: 1 excluded because she did not return post-test questionnaire) had significantly lower DCS score than those in the pamphlet group (n = 150) (DA: -8.41 [SD 8.79] vs. pamphlet: -1.69 [SD 5.91], p < .001). Knowledge of epidural anesthesia and satisfaction with decision-making scores of women who used the DA were significantly higher than those of women who used the pamphlet (p < .001). Women in the DA group showed a significantly lower undecided rate than those in the pamphlet group. The number of undecided women in the DA group significantly decreased from 30.2% to 6.1% (p < .001), whereas that in the pamphlet group remained largely unchanged from 40.7% to 38.9%.
This study indicates that a DA can be useful in helping women make a decision whether to have epidural anesthesia or not for labor during vaginal delivery.
决策辅助工具（DAs）有助于为分娩时使用硬膜外麻醉的决策提供信息。迄今为止，针对日本孕妇的决策辅助工具开发甚少。在此，我们研究了一种决策辅助工具对孕妇决定阴道分娩时是否采用硬膜外麻醉的影响。主要结局指标是平均决策冲突评分的变化。
在这项非随机对照试验中，通过目的抽样法招募了一家城市医院的300名低风险孕妇，并将其分为两组：决策辅助工具组（干预组）和宣传册组（对照组）。先开始对照组入组（直至150名女性），随后进行干预组入组（150名女性）。使用决策冲突量表（DCS）评估主要结局指标的测试前和测试后评分，使用硬膜外麻醉知识和决策满意度评估次要结局指标，以及麻醉使用决策（即使用硬膜外麻醉、不使用硬膜外麻醉或未决定）。
决策辅助工具组的女性（n = 149：1名因未返回测试后问卷而被排除）的决策冲突量表评分显著低于宣传册组的女性（n = 150）（决策辅助工具组：-8.41 [标准差8.79] 对比宣传册组：-1.69 [标准差5.91]，p < .001）。使用决策辅助工具的女性对硬膜外麻醉的知识和决策满意度评分显著高于使用宣传册的女性（p < .001）。决策辅助工具组的女性未决定率显著低于宣传册组。决策辅助工具组中未决定的女性数量从30.2%显著降至6.1%（p < .001），而宣传册组则基本保持不变，从40.7%降至38.9%。
本研究表明，一种决策辅助工具有助于帮助女性决定阴道分娩时是否采用硬膜外麻醉。
