Piloting a shared decision-making clinician training intervention in maternity care in Australia: A mixed methods study

Teena Clerke; Jayne Margetts; Helen Donovan; Heather L Shepherd; Angela Makris; Alison Canty; Annette Ruhotas; Christine Catling; Amanda Henry

doi:10.1016/j.midw.2023.103828

Piloting a shared decision-making clinician training intervention in maternity care in Australia: A mixed methods study

Midwifery. 2023 Nov:126:103828. doi: 10.1016/j.midw.2023.103828. Epub 2023 Sep 12.

Authors

Teena Clerke¹, Jayne Margetts², Helen Donovan², Heather L Shepherd³, Angela Makris⁴, Alison Canty⁵, Annette Ruhotas⁶, Christine Catling², Amanda Henry⁷

Affiliations

¹ Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia. Electronic address: Teena.Clerke@uts.edu.au.
² Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia.
³ The University of Sydney, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Australia.
⁴ Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of New South Wales, Australia; Liverpool Hospital, South West Sydney Local Health District, Australia; Western Sydney University, Women's Health Initiative Translation Unit (WHITU), Australia.
⁵ Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; Liverpool Hospital, South West Sydney Local Health District, Australia; Western Sydney University, Women's Health Initiative Translation Unit (WHITU), Australia.
⁶ Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia.
⁷ Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of New South Wales, Australia; St George Hospital, South East Sydney Local Health District, Australia.

PMID: 37717344
DOI: 10.1016/j.midw.2023.103828

Abstract

Problem: Implementation of woman-centred care in evidence-based maternity practice requires clinicians to be skilled in shared decision-making, yet there is limited training or research into such interventions.

Background: Shared decision-making enables women to make informed decisions in partnership with clinicians where there are varied clinical options in relation to indications for and timing of planned birth.

Aim: We aimed to develop a shared decision-making training intervention and evaluate its feasibility and acceptability to midwives and obstetricians.

Methods: The intervention was co-designed by midwifery and medical clinician-researchers, and a consumer representative. Online training and demonstration videos were distributed to midwives and obstetricians in three Sydney hospitals, followed by two online workshops in 2021 and 2022 where participants practised shared decision-making in roleplaying scenarios tailored to timing of birth. Training was evaluated using post-workshop and post-training surveys and semi-structured qualitative interviews.

Findings: The training workshop format, duration and content were well received. Barriers to the uptake of shared decision-making were time, paternalistic practices and fear of repercussions of centring women in the decision-making process.

Discussion: The intervention enabled midwifery and medical colleagues to learn communication repertoires from each other in woman-centred discussions around timing of birth. Roleplay scenarios enabled participants to observe and provide feedback on their colleagues' shared decision-making practices, while providing a space for collective reflection on ways to promote, and mitigate barriers to, its implementation in practice.

Conclusion: Shared decision-making training supports maternity clinicians in developing skills that implement woman-centred care in the timing of planned birth.

Keywords: Clinician training; Maternity care; Mixed methods; Shared decision-making; Timing of planned birth.

MeSH terms

Decision Making
Decision Making, Shared
Evidence-Based Practice
Female
Humans
Maternal Health Services*
Midwifery* / methods
Obstetrics*
Pregnancy