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Published on: January 12, 2018
Navigating the Grey Zone: A Mixed-Methods Study to Evaluate a Decision Support Tool in the SOGC Late Preterm
Jessica Liauw1, Kayleigh S J Campbell1, Madeleine Ennis1
1Department of Obstetrics and Gynaecology, University of British Columbia.
Objective:
To evaluate the impact of integrating a decision support tool (DST) into the 2023 Society of Obstetricians and Gynaecologists of Canada (SOGC) Technical Update on Antenatal Corticosteroids at Late Preterm Gestation (340-366 weeks') on the frequency and quality of patient counselling.
Methods:
Our mixed-methods study randomized six Canadian hospitals, within three provinces, to receive the Technical Update alone (Guideline-only) or the Technical Update with integrated DST summarizing benefits and harms of late preterm antenatal corticosteroids (Guideline+DST). We administered questionnaires to individuals with a late preterm livebirth before and after guideline release to estimate the DST's effect on frequency and quality of counselling about late preterm antenatal corticosteroids using a difference-in-differences analysis. After guideline release, we interviewed obstetricians and used reflexive thematic analysis to explore factors influencing the DST's impact.
Results:
403 patients were eligible for counselling on late preterm antenatal corticosteroids. The DST had no apparent effect on counselling frequency (Guideline+DST: 11.1% before guideline release vs. 10.6% after; Guideline-only: 9.7% vs. 9.2%; difference-in-differences -0.5% [95% CI: -12.0-11.0]) or quality (satisfaction with communication, difference-in-differences 0 points [-1.30-1.30]; confidence in decision, -0.5 points [-2.20-1.20]). Obstetricians (N = 28) described three themes influencing the DST's impact: (1) limitations accessing the DST; (2) improving knowledge with variable practice change; and (3) uncertain relevance of benefits and harms.
Conclusions:
Integrating a DST into the SOGC Technical Update did not increase the frequency or quality of patient-reported counselling, but some obstetricians reported improved knowledge of benefits and harms of late preterm antenatal corticosteroids.
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