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Patient perception of involvement in medical care during labor and delivery
A Berg1, D Yuval, M Ivancovsky
1JDC-Brookdale Institute, Health Policy Research Program, Jerusalem, Israel. AyeletB@jdc.org.il
Background:
Patients who feel involved in their treatment have better outcomes than those who do not.
Objective:
To identify determinants of perceived patient involvement in obstetric care.
Methods:
A retrospective study was undertaken in 1,452 (83%) of 1,750 women sampled in November 1995 from maternity wards of 14 general hospitals in Israel. A postal and telephone survey using a self-administered questionnaire included the following variables: hospital (identity number), patients' age, self-reported complications, previous deliveries, education, ethnicity, and number of obstetric interventions performed and/or considered. The main outcome measured was the reported involvement in decisions for obstetric interventions.
Results:
Reported full involvement varied from 72% for epidural analgesia to 13% for forceps/vacuum extraction. Factor analysis identified two dimensions of perceived involvement: one for "routine" interventions (enema, monitoring, IV line and episiotomy), which are performed in Israel mostly by midwives, and another for "special" interventions (forceps/vacuum extraction, epidural or other analgesia, and cesarian section) performed by physicians. Logistic regression identified hospitals, younger age, number of interventions, and Arab ethnicity as correlates of a perceived non-involvement in decisions for "special" interventions.
Conclusions:
Clinical setting, age and ethnicity affected patient perception of involvement in decisions for obstetric interventions.
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