Understanding preferences regarding the offer of elective induction of labor to inform development of a decision support tool

了解有关选择性引产的偏好，为决策支持工具的开发提供信息

• 批准号: 10730074
• 负责人: MIRIAM KUPPERMANN
• 金额: $ 9.03万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-05 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10730074
• 关键词: Understanding; preferences; regarding; offer; elective

Project Summary/Abstract – There are no changes to the Project Summary/Abstract as a result of this change of institution Cesarean delivery (CD) is the most common inpatient surgery in the US, accounting for nearly one third of births annually. Numerous organizations have targeted reducing the CD rate as an important public health goal; however, identifying interventions to achieve this goal has proven challenging. In addition, determining when the benefits of delivery outweigh those of ongoing pregnancy is one of the central dilemmas of obstetric care, and defining the optimal timing of delivery from the perspective of the mother and the neonate has been a topic of much debate. Delivery at 39 weeks has been proposed as optimal for the neonate, but it has also been suggested that the widespread use of induction has contributed to the high rate of cesarean deliveries. In addition, the appropriateness of intervening in pregnancy without a clear medical indication is highly controversial. The recent presentation of the findings of the ARRIVE trial, a randomized trial of induction of labor at 39 weeks versus expectant management in more than 6100 nulliparous women, is poised to impact this calculus significantly. In this large multicenter study, elective induction of labor at 39 weeks was associated with a decrease in cesarean rate, a decrease in preeclampsia and a decrease in need for neonatal respiratory support without a statistically significant difference in adverse perinatal outcomes. Given the difficulty in identifying interventions to decrease the cesarean rate and improve maternal outcomes, the potential implications of these findings on obstetric practice are significant. However, while the clinical outcomes associated with elective induction at 39 weeks are compelling, there is much that is unknown about how patients and providers would view such a significant change in practice. In anticipation of clinical guidelines that are likely to recommend the offer of induction of labor at 39 weeks in view of the new data, it is critical that we gain a nuanced understanding of how these stakeholders view the prospect of a routine offer of induction at 39 weeks. In addition, given the potential complexity involved in this discussion as well as the significant population of women who will face this decision, it is an ideal target for a decision tool to improve efficiency and optimize the incorporation of informed patient preferences in this decision. The proposed study seeks 1) to conduct formative research among pregnant women and prenatal care providers regarding how they would view the offer of elective induction of labor at 39 weeks, 2) to use this information in the creation of a prototype decision tool regarding elective induction, and 3) to conduct a pilot study of feasibility and acceptability of the tool. Our ultimate goal is to conduct a randomized trial of this decision support tool to assess its impact on induction rates, cesarean delivery rates, resource utilization, decision quality, and patient satisfaction with the labor and delivery process. Page 1

项目摘要/摘要-项目摘要/摘要未因此发生变更 更改就读院校 剖腹产（CD）是美国最常见的住院手术，占近三分之一 每年的出生。许多组织都将降低CD发病率作为一项重要的公共卫生目标 然而，事实证明，确定实现这一目标的干预措施具有挑战性。此外，确定 当分娩的好处超过那些正在进行的怀孕是产科的中心困境之一， 护理，并从母亲和新生儿的角度确定最佳分娩时机， 一个有很多争论的话题。39周分娩被认为是新生儿的最佳选择，但它也 有人认为，引产的广泛使用导致了剖腹产的高发生率。 此外，在没有明确医学指征的情况下对妊娠进行干预的适当性也很高。 争议 最近介绍的结果ARRIVE试验，一个随机试验的引产在39 在6100多名未经产妇女中， 显著在这项大型多中心研究中，39周时选择性引产与 剖宫产率降低，先兆子痫减少，新生儿呼吸道需要减少， 在围产期不良结局方面没有统计学显著差异。 由于难以确定干预措施，以降低剖宫产率和改善孕产妇死亡率， 结果，这些研究结果对产科实践的潜在影响是显着的。然而，虽然 与39周择期诱导相关的临床结局是令人信服的，但仍有许多未知因素 关于患者和提供者如何看待实践中的这种重大变化。临床预期 鉴于新的数据，可能会建议在39周时提供引产的指导方针， 至关重要的是，我们要细致入微地了解这些利益相关者如何看待常规报价的前景， 第39周的诱导。此外，考虑到这一讨论所涉及的潜在复杂性以及 大量的妇女将面临这一决定，这是一个理想的目标，决策工具，以改善 提高效率，并优化在此决策中纳入知情的患者偏好。 拟议的研究寻求：1）在孕妇和产前护理中进行形成性研究 提供者关于他们如何看待39周时选择性引产的提议，2）使用这一点 在创建关于选修上岗的原型决策工具方面的信息，以及3）进行试点 研究工具的可行性和可接受性。我们的最终目标是进行一项随机试验 决策支持工具，以评估其对诱导率，剖宫产率，资源利用， 决策质量和患者对分娩和分娩过程的满意度。 第1页