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Informing Decision-Making About Caesarean Birth: A Delphi Study to Develop a Core Information Set
Carol Kingdon1, Ben Greenfield1,2, Mahmoud Aljubeh1,2
1Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
Objective:
To develop a caesarean birth core information set. Caesareans are the most common surgery performed in many countries. Women need information for informed decision-making and consent. Core information sets (CISs) provide baseline information, agreed upon by parents and clinicians, for discussion before a procedure.
Design:
Two-phase consensus study using modified Delphi.
Setting:
United Kingdom, 2024.
Sample:
People planning a pregnancy/currently pregnant/new parents and maternity professionals.
Methods:
Phase 1: Long-list of information points identified from 273 systematic reviews, 50 patient leaflets, three pre-existing qualitative studies and a stakeholder survey (n = 230); Operationalised into a Delphi questionnaire comprising 11 information points with 108 items. Phase 2: Think-aloud interviews (n = 9) informed questionnaire restructure into information about planned caesarean birth, unplanned caesarean birth (within 72 h) and emergency caesarean birth (EMCB; ≤ 30 min), followed by two-round Delphi survey and consensus meetings.
Results:
N = 360 participated in the Delphi survey Round 1. All items were carried forward, and three were added for Round 2 (n = 188/56.4% attrition rate). From Round 2, one item was removed, 73 included and 37 items no-consensus. Free-text responses identified an unmet need for a postnatal EMCB-CIS. Over four meetings (n = 36) consensus was reached for an antenatal-caesarean-birth-CIS (14 points), EMCB-CIS (5 points) and a postnatal EMCB-CIS (12 points).
Conclusions:
This study has established three caesarean birth CISs to support informed decision-making discussions between women and clinicians: (1) an antenatal CIS for planned and unplanned caesareans when there is time for discussion in clinic; (2) a one-page CIS for emergency caesarean birth (within 30 min) when there is little time for discussion; (3) and a postnatal CIS for use after an unplanned caesarean birth before hospital discharge.
Trial Registration:
COMET Initiative | Development of a core information set for caesarean birth (comet-initiative.org).
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