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Shared decision making with breast cancer patients – does it work?
289 Labouring together: shared decision making and interprofessional collaboration in maternity care
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  1. Vanessa Watkins1,
  2. Cate Nagle2,3,
  3. Maryann Street1,4,
  4. Bridie Kent5,
  5. Alison M Hutchinson1,6
  1. 1Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
  2. 2James Cook University, Queensland, Australia
  3. 3Townsville Hospital and Health Service, Queensland, Australia
  4. 4Centre for Quality and Patient Safety – Deakin University – Eastern Health Partnership, Box Hill, Victoria, Australia
  5. 5School of Nursing and Midwifery, University of Plymouth, UK
  6. 6Centre for Quality and Patient Safety Research Deakin University – Barwon Health Partnership, Geelong, Victoria, Australia

Abstract

Introduction Partnering with women is central to maternity care, supported by principles of shared decision making (SDM) and interprofessional collaboration (IPC). The Labouring Together study was conducted to explore women’s and clinicians’ perceptions and experiences of SDM and IPC in maternity care in Victoria, Australia.

Methods Underpinned by conceptual theories of SDM and IPC, a sequential, mixed-methods approach was used to explore stakeholder perceptions and experiences in four diverse case studies. Surveys using the Control Preferences Scale (CPS) and interviews incorporating the Decisional Conflict Scale (DCS) were used to explore women’s experiences of SDM. Surveys were conducted with clinicians, using the Context Assessment Index (CAI) and the Jefferson Scale of Attitudes Toward Collaboration, followed by interviews to explore their perceptions and experiences of SDM and IPC.

Results Although most women preferred an autonomous or collaborative role for SDM, many reported experiencing a passive decision-making role. The context of each case study was rated similarly by clinicians for the provision of woman-centred care; however, midwives were found to have a significantly more positive attitude toward IPC than obstetricians (p<.001 95% CI 2.64–7.93) and GPs (p<.001 95% CI 5.48–12.10). Following synthesis of findings, factors mediating SDM and IPC were identified at all levels of healthcare. Central themes include Relationships, Professional Partnerships, Organisational Systems and Culture, and Governance and Policy.

Discussion There was universal acknowledgement that women should be equal partners in collaborative SDM, yet there is disparity in understanding of how this may be achieved under the current conditions in maternity care.

Conclusion(s) Results of the Labouring Together study indicate that although individual attitudes are largely positive, fundamental barriers remain, and SDM with women is not routine practice in maternity care in Victoria, Australia.

https://doi.org/10.1136/bmjebm-2024-SDC.288

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