Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Hamm and Levine).
Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Hamm and Levine).
Am J Obstet Gynecol MFM. 2021 May;3(3):100321. doi: 10.1016/j.ajogmf.2021.100321. Epub 2021 Jan 22.
We previously conducted a prospective cohort study (n=1610) demonstrating that the implementation of a validated calculator to predict likelihood of cesarean delivery during labor induction was associated with reduced maternal morbidity, reduced cesarean delivery rate, and improved birth satisfaction.
To optimize future implementation, we used qualitative interviews to understand the clinician perspective on: (1) the cesarean delivery risk calculator implementation and (2) the mechanisms by which the use of the calculator resulted in the observed improved outcomes.
After completion of the prospective study (June 30, 2019), 20 trainees and attending clinicians (including nurse-midwives, obstetrical physicians, and family medicine physicians) at the study site participated in a single, brief semistructured interview from March 1, 2020, to June 30, 2020. Transcriptions were coded using a systematic approach.
Overall, clinicians had favorable perspectives regarding the cesarean delivery risk calculator. Clinicians described the calculator as offering "objective data" and a "standardized snapshot of the labor trajectory." Concerns were raised regarding "overreliance" on calculator output. Barriers to use included time for patient counseling and "awkwardness" around the interactions and perceived patient misunderstanding of the calculator result. Although most senior clinicians (n=8) reported that the calculator did not impact patient management, trainee clinicians (n=12) more often felt that the calculator influenced care at the extremes of cesarean delivery risk. Furthermore, more senior clinicians felt "neutral" regarding any impact of counseling patients on cesarean delivery risk compared with trainee clinicians, who felt that the counseling "built [patient-clinician] trust."
This qualitative evaluation characterized the generally positive clinician perspective around the cesarean delivery risk calculator, while identifying specific facilitators and barriers to implementation. In addition, we elucidated potential mechanisms by which the calculator may have been related to clinician decision making and patient-clinician interactions, leading to reduced maternal morbidity and improved patient birth satisfaction. This information is important as widespread implementation of the cesarean delivery risk calculator begins.
我们之前进行了一项前瞻性队列研究（n=1610），结果表明，在引产期间实施经过验证的计算器来预测剖宫产的可能性与降低产妇发病率、降低剖宫产率和提高分娩满意度有关。
为了优化未来的实施，我们使用定性访谈来了解临床医生对以下方面的看法：（1）剖宫产风险计算器的实施，以及（2）使用计算器产生观察到的改善结果的机制。
在前瞻性研究完成后（2019 年 6 月 30 日），2020 年 3 月 1 日至 2020 年 6 月 30 日，研究现场的 20 名受训者和主治医生（包括助产士、产科医生和家庭医生）参与了一次简短的半结构化访谈。使用系统方法对转录本进行编码。
总的来说，临床医生对剖宫产风险计算器持有利看法。临床医生将计算器描述为提供“客观数据”和“分娩轨迹的标准化快照”。他们对“过度依赖”计算器的输出表示担忧。使用的障碍包括为患者咨询留出时间，以及围绕计算器结果的交互和患者的误解而感到“尴尬”。尽管大多数资深医生（n=8）报告称计算器不会影响患者的管理，但 12 名受训医生（n=12）更常认为计算器会影响剖宫产风险极端情况下的护理。此外，与受训医生相比，更多的资深医生对咨询患者剖宫产风险对任何影响的看法“中立”，而受训医生则认为咨询“建立了（医患）信任”。
这项定性评估描述了临床医生对剖宫产风险计算器的普遍积极看法，同时确定了实施的具体促进因素和障碍。此外，我们阐明了计算器可能与临床医生决策和医患互动相关的潜在机制，从而降低产妇发病率和提高患者分娩满意度。随着剖宫产风险计算器的广泛实施，这些信息非常重要。
