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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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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cited_by cdi_FETCH-LOGICAL-c512t-6f23decef74edf22ef8e728d61d3742e6eef3e0c6a0f27e36a2eb6c792694113
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creator Sharma, Poonam S
Eden, Karen B
Guise, Jeanne-Marie
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Dolan, James G
description 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
doi_str_mv 10.1016/j.jclinepi.2010.02.011
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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 &lt;0.001). The multiattribute model favored repeat cesarean because women heavily prioritized avoiding any risk (even rare risk) to the infant. The hybrid model favored the trial of labor because of lower probabilities of risk to the mother and its high success rate of vaginal birth after cesarean. Conclusion This study highlights the importance of patients and clinicians discussing the patient's priorities regarding the risks and other nonclinical considerations that may be important to her in the birthing decision.</description><identifier>ISSN: 0895-4356</identifier><identifier>EISSN: 1878-5921</identifier><identifier>DOI: 10.1016/j.jclinepi.2010.02.011</identifier><identifier>PMID: 20558035</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Analytic Hierarchy Process ; Biological and medical sciences ; Cesarean Section - psychology ; Cesarean Section, Repeat - psychology ; Childbirth ; Childbirth &amp; 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 &amp; numerical data ; Pregnancy ; Probability ; Risk communication ; Risk Factors ; Shared decision making ; Surveys and Questionnaires ; Trial of Labor ; Vagina ; Vaginal Birth after Cesarean - psychology ; VBAC</subject><ispartof>Journal of clinical epidemiology, 2011, Vol.64 (1), p.67-78</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c512t-6f23decef74edf22ef8e728d61d3742e6eef3e0c6a0f27e36a2eb6c792694113</citedby><cites>FETCH-LOGICAL-c512t-6f23decef74edf22ef8e728d61d3742e6eef3e0c6a0f27e36a2eb6c792694113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4022,27922,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=23873007$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20558035$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sharma, Poonam S</creatorcontrib><creatorcontrib>Eden, Karen B</creatorcontrib><creatorcontrib>Guise, Jeanne-Marie</creatorcontrib><creatorcontrib>Jimison, Holly B</creatorcontrib><creatorcontrib>Dolan, James G</creatorcontrib><title>Subjective risk vs. objective risk can lead to different post-cesarean birth decisions based on multiattribute modeling</title><title>Journal of clinical epidemiology</title><addtitle>J Clin Epidemiol</addtitle><description>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 &lt;0.001). The multiattribute model favored repeat cesarean because women heavily prioritized avoiding any risk (even rare risk) to the infant. The hybrid model favored the trial of labor because of lower probabilities of risk to the mother and its high success rate of vaginal birth after cesarean. 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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 &lt;0.001). The multiattribute model favored repeat cesarean because women heavily prioritized avoiding any risk (even rare risk) to the infant. The hybrid model favored the trial of labor because of lower probabilities of risk to the mother and its high success rate of vaginal birth after cesarean. Conclusion This study highlights the importance of patients and clinicians discussing the patient's priorities regarding the risks and other nonclinical considerations that may be important to her in the birthing decision.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20558035</pmid><doi>10.1016/j.jclinepi.2010.02.011</doi><tpages>12</tpages></addata></record>
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1878-5921
language eng
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source Elsevier
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
title Subjective risk vs. objective risk can lead to different post-cesarean birth decisions based on multiattribute modeling
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