Subjective risk vs. objective risk can lead to different post-cesarean birth decisions based on multiattribute modeling

Abstract Objective To compare birth recommendations for pregnant women with a prior cesarean produced from a decision model using absolute risks vs. one using subjective interpretation of the same risks: (1) a multiattribute decision model based on patient prioritization of risks (subjective risk) a...

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Bibliographic Details
Published in:Journal of clinical epidemiology 2011, Vol.64 (1), p.67-78
Main Authors: Sharma, Poonam S, Eden, Karen B, Guise, Jeanne-Marie, Jimison, Holly B, Dolan, James G
Format: Article
Language:English
Subjects:
Analytic Hierarchy Process
Biological and medical sciences
Cesarean Section - psychology
Cesarean Section, Repeat - psychology
Childbirth
Childbirth & labor
Choice Behavior
Decision Support Techniques
Decision tree
Delivery. Postpartum. Lactation
Epidemiology
Female
Gynecology. Andrology. Obstetrics
Health Knowledge, Attitudes, Practice
Humans
Hysterectomy
Internal Medicine
Medical sciences
Models, Statistical
Pain
Patient Satisfaction - statistics & numerical data
Pregnancy
Probability
Risk communication
Risk Factors
Shared decision making
Surveys and Questionnaires
Trial of Labor
Vagina
Vaginal Birth after Cesarean - psychology
VBAC
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Summary:Abstract Objective To compare birth recommendations for pregnant women with a prior cesarean produced from a decision model using absolute risks vs. one using subjective interpretation of the same risks: (1) a multiattribute decision model based on patient prioritization of risks (subjective risk) and (2) a hybrid model that used absolute risks (objective risk). Study Design and Setting The subjective risk multiattribute model used the Analytic Hierarchy Process to elicit priorities for maternal risks, neonatal risks, and the delivery experience from 96 postnatal women with a prior cesarean. The hybrid model combined the priorities for delivery experience obtained in the first model with the unadjusted absolute risk values. Results The multiattribute model generated more recommendations for repeat cesarean delivery than the hybrid model: 73% vs. 18%, ( P -value
ISSN:0895-4356
1878-5921
DOI:10.1016/j.jclinepi.2010.02.011