This study will use an interactive decision-aid, using health IT, to promote shared decision making between pregnancy care providers and women facing difficult choices about birth after previous cesarean. A mixed-methods design will be used to develop and evaluate the Birth Choices Interactive Tool. The study will have 2 phases: Phase I will use an iterative and participatory action research approach, engaging targeted users (pregnant women and pregnancy care providers) in the interactive tool design and developing a decision-aid that is acceptable to pregnant women and providers. Phase II will assess the feasibility of integrating the interactive decision-aid into two busy urban outpatient settings usig a Shared Decision Making framework. This study represents new work on translating static and generic decision-aids into responsive and interactive decision-aids using electronic learning design principles. Health IT will enable women to interact with evidence-based information, tailor information to their individual history and health factors, help them to communication personal values and preferences with providers, and ultimately have shared decisions documented in their electronic medical record. The two aims for this study are;
Aim 1 : To translate the best-practice Birth Choices paper-based decision-aid into an interactive computer-based decision-aid to support women making decisions about mode of birth after prior cesarean Aim 2: To assess the feasibility of integrating the Birth Choices interactive decision-aid into busy urban outpatien pregnancy care settings using a Shared Decision Making model. The critical health decision point being studied is birth after previous cesarean, meeting an urgent need to promote better communication between women and providers about the risks and benefits of planned VBAC and repeat cesarean. This study will address gaps in current knowledge about integrating decision-aids into diverse practice environments to develop shared understanding between women and providers about their values, preferences, and personal interpretations of risk around childbirth. Opportunities for women to participate actively in decisions about birth depend on the ability of providers to support shared decision making, the availability of effective decision support tools for women and effective ways to integrate decision support tools into busy clinical practice settings. This foundation work will help identify how interactive decision-aids can be integrated into practice settings to provide """"""""patient-centered care"""""""" that is """"""""responsive to needs and preferences of individual patients"""""""".

Public Health Relevance

This important study will identify how interactive decision-aids can be used to provide patient- centered care that responds to needs and preferences of individual patients. A new Birth Choices interactive tool will guide pregnant women with previous history of cesarean birth to actively participate in decision making with their care provider about which method of birth is best for them. Birth Choices health IT will provide individualized information to help women communicate values and preferences for birth and have shared decisions documented.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Exploratory/Developmental Grants (R21)
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Health Care Technology and Decision Science (HTDS)
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Grace, Erin
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Yale University
Schools of Nursing
New Haven
United States
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Shorten, Allison; Fagerlin, Angela; Illuzzi, Jessica et al. (2015) Developing an Internet-Based Decision Aid for Women Choosing Between Vaginal Birth After Cesarean and Planned Repeat Cesarean. J Midwifery Womens Health 60:390-400