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Shared decision making with breast cancer patients – does it work?
290 Labouring together: insights from women on shared decision making 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). This study was conducted to explore perceptions and experiences of SDM and interprofessional collaboration in maternity care in Victoria, Australia. The experiences of women will be presented.

Methods Underpinned by conceptual theories of SDM a sequential, mixed-methods approach was used to explore women’s 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 experiences of SDM. Chi-square analysis was conducted on survey data by case and socio-demographic characteristics. In depth interviews to explore preferences and experiences reported by women incorporated the Decisional Conflict Scale (DCS). Inductive qualitative analysis was conducted, and cross-case analyses were conducted upon the convergent lines of enquiry to triangulate data and draw conclusions.

Results Most women (84%) preferred an autonomous or collaborative role for SDM, However, the role experienced by most women was collaborative or passive χ2 (4 N=176) = 32.239, p<.001. Statistically significant differences were identified between women’s preferences and experiences of SDM in the private obstetric care model compared to public maternity care. Impacts upon women’s autonomy over decision-making in maternity care included: access to midwifery and relational continuity models of care; understanding of the rights of the woman; and style risk discussions.

Discussion Findings provide an imperative to use SDM processes to engage women in decision-making in maternity care. However, many women do not experience SDM, as bureaucratic style decision-making based upon a dominant discourse of risk avoidance has power to ultimately veto the woman’s choice.

Conclusion(s) Findings of the Labouring Together study indicate that fundamental barriers hinder SDM with women in maternity care in Victoria, Australia.

https://doi.org/10.1136/bmjebm-2024-SDC.289

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