A randomised controlled trial of a decision aid for the management of pain in labour and childbirth

许多研究表明，妇女希望参与关于她们在怀孕期间接受治疗的临床决策，参与决策增加了对产妇护理的满意度。决策辅助是一种干预措施，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。该项目旨在开发和评估世界上第一个关于分娩和分娩疼痛管理的妇女决策援助。管理分娩疼痛的决策援助既实用又及时，因为有关于分娩镇痛的强有力的证据基础，但缺乏针对妇女的循证信息。例如，关于硬膜外镇痛的小册子概述了硬膜外镇痛的好处，如完全缓解疼痛，但没有提供任何关于产科不良后果的信息，如助产风险增加一倍。大多数女性愿意经历分娩时的痛苦，但不希望痛苦压倒她们。决策援助将包括一系列可用于缓解分娩和分娩疼痛的药物和非药物选择。每一种选择都有好处和风险，这些好处和风险的相对重要性对妇女个人来说是不同的，在这种情况下，决策援助产生最大的好处。在这个项目中开发的疼痛管理决策辅助工具将基于最新的可用证据和结果。它将包括一本练习册、录音带CD和工作表，指导(但不是直接)女性使用最适合她们的疼痛管理选项，大约需要30分钟才能完成。将对决策辅助进行评估，以评估对妇女对决策、知识、焦虑和妊娠结局的满意度的影响。如果成功，这些结果可以应用于改善消费者信息，并在广泛的妊娠护理问题上参与临床决策。

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 regarding the management of pain in labour and childbirth. A decision aid for managing the pain of childbirth is both practical and timely because there is a strong evidence base on labour analgesia but a lack of evidence-based information for women. For example, brochures on epidural analgesia outline the advantages of epidurals such as complete amelioration of pain, but do not present any information on adverse obstetric outcomes such as the doubling of risk for an instrumental birth. Most women are willing to experience pain in childbirth but do not want pain to overwhelm them. The decision aid will include a range of available drug and non-drug options for pain relief in labour and childbirth. Each of the options 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 pain management decision aid developed in this project will be based on the best most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women with their pain management options that best suit them, taking ~30 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.