Why did we do this research?

SDM is an international healthcare priority. It provides short- and long-term benefits for women, and their families. It is associated with improved birth experiences, improved maternal mental health outcomes, reduced pre-term birth, higher birth weights, and enables safer care. Failing to involve women can lead to their feeling out of control and powerless, leading to negative birth experiences. Women repeatedly report not being involved in decisions regarding their care.

What is Shared Decision Making?

Methods

This review was reported in accordance with PRISMA guidance, and registered in PROSPERO. Searches occurred in October 2020 were conducted in BNI, CINAHL, Embase, Medline, PsycINFO, and Cochrane Central. Searches will be re-run prior to submission for publication. Screening occurred in duplicate and eligible studies were sought for retrieval and included in full text screening. Data extraction occurred in duplicate using a pre-defined data extraction tool.

Risk of bias (ROB) assessment

ROB-2 was used to assess ROB in randomised control trials (RCTs) and ROBINS-I were used to assess ROB in non-randomised studies (NRS).

Results

16 studies, reported in 22 records.

14 RCTs, including one cluster RCT, two NRS including one prospective cohort control study, and one before and after cohort study.

ROB

12 RCTs were of overall high risk of bias, two had some concerns. The most frequent cause for bias were: risk of bias due to deviations from the intended interventions, and risk of bias in selection of the reported results. Of the NRS one was of moderate ROB, and one of serious ROB.

Interventions

Decision aids

13 studies involved decision aids. All decision aid interventions involved information giving on the risks and benefits of different management options, and value clarification exercises.  

Decision support counselling

Three studies tested DA with decision support counselling, two studies tested only decision support counselling interventions. Decision support counselling involved at least one face to face consultation with a trained researcher or MHCP in which women were encouraged to express preferences, discuss their fears and concerns.

Educational programme

One study tested an educational programme.

Types of decisions

Conclusion

Interventions to improve SDM use multiple and varied outcome measures. Decision aids may help to improve SDM, however meta-analysis of these results is ongoing and yet to determine effect size and significance. Agreed outcome measures for SDM may have to improve evaluation and therefore improvement of decision making in maternity care.