Development and evaluation of a decision aid for women with a breech-presenting baby.

许多研究表明，妇女希望参与关于她们在怀孕期间接受的治疗的临床决策，参与决策可以提高对产妇护理的满意度。决策辅助工具是通过提供与个人健康相关的选择和结果的信息，帮助人们做出具体和深思熟虑的决定的干预措施。该项目旨在开发和评估世界上第一个为妊娠晚期臀先露婴儿（底部而不是头部先露）的妇女提供的决策辅助工具。一个决定援助臀位是及时的，因为最近的结果，国际试验已经大大改变了妇女的选择，在管理臀位。阴道臀位分娩与计划剖腹产（CS）的试验发现，有压倒性的证据表明，计划剖腹产的妇女婴儿死亡和残疾减少。计划剖宫产现在被认为是分娩时臀先露的最佳实践。然而，对于臀先露的女性，另一种治疗方法是在分娩前先将臀位翻转到头部（称为外部头位翻转，ECV）。这些选择（ECV或计划CS）中的每一个都有好处和风险，这些好处和风险的相对重要性因个体女性而异，这是一种决策辅助产生最大好处的情况。本项目中开发的后膛决策辅助工具将基于最佳和最新的可用证据和结果。它将包括一本工作手册，录音带CD和工作表，将指导（但不直接）妇女选择最适合他们的治疗方案，需要大约20分钟才能完成。将对决策辅助工具进行评价，以评估对妇女对决策、知识、焦虑和怀孕结果的满意度的影响。如果成功，研究结果可以应用于改善消费者信息和参与广泛的妊娠护理问题的临床决策。

Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby (bottom rather than head first) in late pregnancy. A decision aid for breech presentation is timely because recent results of an international trial have dramatically altered women's options in the management of breech presentation. The trial of vaginal breech birth versus planned caesarean section (CS) found overwhelming evidence of reduced infant death and disability for women with a planned CS. Planned CS is now considered best practice for delivery of a breech presentation at birth. However, another treatment option for women with a breech presentation is turning the breech to head first before birth (called external cephalic version, ECV). Each of these options (ECV or planned CS) has benefits and risks, and the relative importance of these benefits and risks varies for individual women, a scenario where a decision aid produces the greatest benefit. The breech decision aid developed in this project will be based on the best and most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women to a treatment option that best suits them, taking ~20 minutes to complete. The decision aid will be evaluated to assess the impact on women's satisfaction with decision making, knowledge, anxiety and pregnancy outcomes. If successful, the results could be applied to improve consumer information and participation in clinical decisions across a wide spectrum of pregnancy care issues.