Measuring Preferences for Childbirth After Cesarean

描述（由申请人提供）：随着剖宫产率继续攀升，面临是否再次剖宫产或尝试剖宫产后阴道分娩（VBAC）决定的妇女人数（目前每年约420，000人）也将增加。 这项为期18个月的探索性研究的目的是帮助孕妇使用主要研究者开发的偏好评估计算机模块权衡分娩决策的风险和益处。 拟议研究的长期目标是通过创建计算机化的分娩决策辅助工具，了解和改善这些妇女的决策过程。 当决策很复杂、结果不确定、人们对偏好的优先顺序各不相同时，这种决策辅助工具就能提供价值。 有剖宫产史的妇女的分娩决定符合所有这些标准。 迄今为止，还没有研究量化妇女在分娩决定中如何权衡各种考虑因素-医疗和其他因素-的复杂性。 因此，拟议的研究意义重大，因为它将提供一种急需的方法，帮助妇女优先考虑和权衡与分娩决定有关的偏好。 更广泛地说，它响应了最近NIH和AHRQ的倡议，以促进计算机决策辅助工具的发展，提高医疗决策的质量。 一名新的研究人员将领导一个合格的，多学科的团队，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. 验证一种精确的方法，用于测量正在考虑再次剖宫产或剖宫产后阴道分娩（VBAC）的孕妇的分娩偏好。 在本研究的初始阶段，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效度。 2. 为了测试使用偏好评估计算机模块的女性与对照组的女性相比，是否对自己的偏好以及这些偏好的含义更加清晰。 我们将对有剖宫产史的孕妇进行随机对照试验。 该偏好评估计算机模块不仅适用于VBAC决策，还适用于与择期剖腹产和引产相关的决策。 简而言之，拟议中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.