Development Of Decision Aid With Ottawa Decision Support Framework For Pregnant Women With Prenatal Screening And Diagnostic Decision-making

ObjectiveInvestigation of prenatal screening and diagnosis of cognitive conflict,decision-making,decision-making status and its influencing factors,explore the prenatal screening and diagnosis decision-making process experience,understanding of pregnant women decision-making needs,using Delphi method to Ottawa,based on the decision support framework of prenatal screening and diagnosis decision aid tool,for prenatal screening and diagnosis decision-making to provide support and assistance,provide the basis for promoting patients to participate in decision-making.MethodsIn this study,the quantitative and qualitative methods were combined to explore the decision-making issues of prenatal screening and diagnosis of pregnant women in a deep level,and the Delphi expert letter consultation method was used to construct a prenatal screening and diagnosis decision-making aid tool based on the Ottawa decision support framework.In this study,the method of convenience sampling was used to conduct a questionnaire survey in the obstetrics department of a third-level first-class hospital in Shandong Province from February to October in 2020.The questionnaire included general information of pregnant women,questionnaires on cognition and decision-making of prenatal screening and diagnosis,and decision-making conflict scale.In the qualitative study,16 pregnant women who meet the conditions of the survey were interviewed face to face in the form of semi-structured interviews.Colaizzi’s 7-step analysis method was used for data analysis.Two rounds of letter consultation were conducted for 16 experts who met the inclusion criteria using Delphi expert letter consultation method.Statistical tools in this study include Excel2016,SPSS21.0,statistical methods include statistical description,statistical inference,etc.,the test level α<0.05.Results1.The quantitative study results showed that pregnant women generally lacked awareness of prenatal screening and diagnosis.An absolute majority(95.7%)of pregnant women were able to accept NIPT,and 62.3%of pregnant women were unable to accept prenatal diagnosis,mainly because prenatal diagnosis may have operational risks;65.7%of pregnant women expressed a strong willingness to share decision-making in the decision-making mode of prenatal testing and diagnosis.The total conflict between prenatal screening and diagnosis decision was 15.04±14.80.Prenatal screening and diagnosis decision conflicts in the place of residence,monthly family income,pregnant women with and without understanding the way of prenatal screening and diagnosis,prenatal screening and diagnosis of cognitive degree of statistical significance(P<0.05),prenatal screening and diagnosis of cognitive degree,family income is the effect of prenatal screening and diagnosis decision conflicts important influencing factors.2.Through qualitative research,three themes have been extracted from the experience of decision-making process of pregnant women’s prenatal screening and diagnosis:decision-making mode,decision-making influencing factors and decision-making needs.3.By the method of expert letter consultation,a decision aid tool for pregnant women’s prenatal screening and diagnosis with 5 first-level indicators and 44 second-level indicators based on the Ottawa decision support framework was finally developed in this study;In this process,the enthusiasm,authority,concentration and coordination of expert opinions are all good,and the research results are scientific to a certain extent.Conclusions1.Prenatal screening and diagnosis of cognitive status,pregnant women to find ways to make relevant decisions,by sharing decision-making departments should strengthen the prenatal screening and diagnosis of propaganda and education,the standard genetic counseling process,reduce or reduction treatment costs,pregnant women to reduce the economic burden,to improve prenatal screening and diagnosis of adherence,ensure the security of the maternal and infant.2.Medical staff should pay attention to the decision-making needs of pregnant women in the decision-making process of prenatal screening and diagnosis,understand their cognition of disease,prenatal screening and diagnosis,decision-making needs and psychological status,provide them with decision-making assistance,share decision-making information,improve their decision-making participation,and enable them to make the best decision.3.This study developed the decision aid with ottawa decision support framework for pregnant women with prenatal screening and diagnostic decision-making,through the statistical analysis has the scientific nature,reliability,under the background of genetic counseling in China is not sound,blend in the concept of Shared decision making decision aid tool,to get a decision aid for the decision of prenatal screening and diagnosis and support,to improve awareness and understanding of pregnant women related to clarify the pros and cons relationship and personal values,reduce the decision conflicts,encourage pregnant women to make the best decisions,the decision aid tool has a certain clinical applicability.