Measuring Preferences for Childbirth After Cesarean

描述(申请人提供)：随着剖腹产出生率的持续攀升，面临是否再次剖腹产或剖腹产后尝试阴道分娩(VBAC)的女性数量(目前约为每年42万人)也将增加。这项拟议的为期18个月的探索性研究的目标是帮助孕妇使用首席研究员开发的偏好评估计算机模块在分娩决定中权衡风险和好处。拟议研究的长期目标是通过创建一种计算机化的分娩决策辅助工具来了解和改进这些妇女的决策过程。当决策复杂时，当结果不确定时，当人们对偏好的优先顺序不同时，这样的决策辅助工具就会提供价值。有过剖腹产经历的妇女的生育决定符合所有这些标准。 到目前为止，还没有一项研究量化女性在分娩决定中如何权衡各种考虑因素的复杂性--医疗和其他方面。因此，这项拟议的研究具有重要意义，因为它将提供一种亟需的方法，帮助女性优先考虑和权衡与生育决定相关的偏好。更广泛地说，它响应了NIH和AHRQ最近的倡议，以促进计算机决策辅助工具的发展，以提高医疗决策的质量。一名新的调查员将领导一支资历良好、多学科的团队，该团队在决策分析、产科医学和研究方法方面具有专业知识，以追求以下具体目标： 1.验证在考虑再次剖腹产或剖腹产后阴道分娩(VBAC)的孕妇中衡量生育偏好的准确方法。在这项研究的初始阶段，我们将验证偏好评估计算机模块的准确性，测量内部一致性，并在横断面研究中评估内容有效性。 2.与对照组相比，测试使用偏好评估计算机模块的女性是否会更清楚地了解自己的偏好--以及这些偏好的含义。我们将对有过剖腹产经历的孕妇进行随机对照试验。 这个偏好评估计算机模块不仅适用于VBAC决策，而且还适用于与选择性剖腹产和引产相关的决策。简而言之，拟议的研究将通过提高分娩决策过程的质量来推动该领域的发展。

DESCRIPTION (PROVIDED BY APPLICANT): As cesarean birth rates continue to climb, the number of women (currently about 420,000 annually) facing the decision of whether to have a repeat cesarean or to attempt a vaginal birth after cesarean (VBAC) will also increase. The objective of this proposed 18-month exploratory research study is to help pregnant women weigh risks and benefits in a childbirth decision using the Preferences-Assessment Computer Module developed by the principal investigator. The long-term objective of the proposed research is to understand and improve the decision-making process of these women by creating a computerized childbirth decision aid. Such decision aids provide value when the decision is complex, when the outcome is uncertain, and when people vary in how they prioritize preferences. Childbirth decisions for women with a prior cesarean meet all these criteria. No study to date quantifies how women weigh the complexities of various considerations--medical and otherwise--in the delivery decision. The proposed research is significant, therefore, in that it will provide a much-needed method to help women prioritize and weigh their preferences related to childbirth decisions. More broadly, it responds to the recent NIH and AHRQ initiatives to promote the development of computerized decision aids to improve the quality of medical decisions. A new investigator will lead a well-qualified, multidisciplined team that has expertise in decision analysis, obstetric medicine, and research methodology in pursuit of the following specific aims: 1. To validate a precise method for measuring childbirth preferences among pregnant women who are considering either a repeat cesarean or a vaginal birth after a cesarean (VBAC). During the initial phase of this study, we will verify the accuracy of the Preferences-Assessment Computer Module, measure internal consistency, and assess content validity in a cross-sectional study. 2. To test whether women who use the Preferences-Assessment Computer Module will have increased clarity about their preferences--and about the implication of those preferences--in comparison to women in a control group. We will conduct a randomized controlled trial of pregnant women with a prior cesarean. This Preferences-Assessment Computer Module is appropriate to address not only VBAC decisions, but also decisions related to elective cesareans and induction. In short, the proposed research will advance the field by improving the quality of the decision-making process for childbirth.