Park Yunseo Linda, Clifton Briana, Ashraf Rida, Barlow Rose, Anderson Alexandra, Altamirano Valeria, Miller Emily, Neuman Mark, Lim Grace
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine.
Brown University, Women and Infant's Hospital.
Res Sq. 2024 Aug 30:rs.3.rs-4814545. doi: 10.21203/rs.3.rs-4814545/v1.
There is a lack of evidence on the importance of pain or other aspects of clinical care in the overall patient experience and patient-centered outcomes in cesarean delivery. The purpose of this study was to discover patient priorities in cesarean delivery anesthesia experience, to compare patient and provider perspectives, and to explore attitudes on shared decision-making around anesthesia choices for cesarean delivery.
Patients with recent cesarean deliveries and clinical care providers were approached using a purposeful sampling strategy for this prospective observational qualitative study. Patients were included if they were in the hospital within 72 hours of a cesarean delivery (scheduled or unscheduled), spoke English fluently, and had term gestation. Providers were included if they currently provide regular clinical care to patients having cesarean deliveries and have at least 3 years of practice experience. Semi-structured interviews were conducted using an interview guide. Interview transcripts were independently coded by three coders and qualitatively analyzed for major themes until thematic saturation was achieved.
A total of 42 participants (20 patients and 22 providers) completed interviews. Five major themes emerged reflecting patient attitudes and beliefs toward cesarean delivery experience: 1) effective communication, education, and respect; 2) emotional support by care team; 3) intraoperative pain or discomfort; 4) varying acceptability around pain therapies; 5) stigma surrounding cesarean delivery. Five major themes emerged reflecting provider attitudes and beliefs toward cesarean delivery priorities: 1) complexity of pain responses; 2) multiple pain control strategies; 3) effective communication during emergency cesarean delivery; 4) patient psychological well-being during cesarean delivery; 5) barriers to observing the patients' birth plans.
Patients and providers alike prioritize pain management, psychological well-being, and effective communication during cesarean delivery experiences. Patients emphasize relationships and trust in their cesarean experience, while clinicians emphasize clinical complexities and physical treatments. Our results guide future research in patient perspectives in cesarean deliveries.
关于剖宫产中疼痛或临床护理的其他方面在整体患者体验和以患者为中心的结局中的重要性，目前缺乏证据。本研究的目的是发现患者在剖宫产麻醉体验中的优先事项，比较患者和提供者的观点，并探讨对剖宫产麻醉选择共同决策的态度。
采用有目的抽样策略，对近期剖宫产患者和临床护理提供者进行这项前瞻性观察性定性研究。如果患者在剖宫产（计划内或计划外）后72小时内住院、能流利说英语且足月妊娠，则纳入研究。如果提供者目前为剖宫产患者提供常规临床护理且至少有3年实践经验，则纳入研究。使用访谈指南进行半结构化访谈。访谈记录由三名编码员独立编码，并对主要主题进行定性分析，直至达到主题饱和。
共有42名参与者（20名患者和22名提供者）完成了访谈。出现了五个主要主题，反映了患者对剖宫产体验的态度和信念：1）有效的沟通、教育和尊重；2）护理团队的情感支持；3）术中疼痛或不适；4）对疼痛治疗的不同接受度；5）剖宫产的污名化。出现了五个主要主题，反映了提供者对剖宫产优先事项的态度和信念：1）疼痛反应的复杂性；2）多种疼痛控制策略；3）急诊剖宫产时的有效沟通；4）剖宫产时患者的心理健康；5）遵守患者分娩计划的障碍。
患者和提供者都将剖宫产体验中的疼痛管理、心理健康和有效沟通列为优先事项。患者强调剖宫产体验中的关系和信任，而临床医生则强调临床复杂性和物理治疗。我们的结果为未来关于剖宫产患者观点的研究提供了指导。
