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Evaluating shared decision-making in periviable counseling using objective structured clinical examinations

Journal of Perinatology volume 39, pages 857–865 (2019)Cite this article

Subjects

Abstract

Objective

To develop and test an Objective Structured Clinical Examination to evaluate the use of shared decision-making (SDM) in periviable counseling among fourth-year OB/GYN residents.

Methods

Residents counseled a standardized patient presenting with preterm premature rupture of membranes at 23 weeks’ gestation. Braddock’s 9-item measure of SDM was adapted to a 10-item scoring rubric; rating each: 0 (absent), 1 (partial), or 2 (complete).

Results

Twenty-six residents participated. All provided “complete” discussions of the clinical issue and “complete” or ‘partial’ ratings for informing the woman of her prognosis (62 and 38%, respectively) and addressing her role in decision-making (42 and 50%). Discussions of her goals and preferences were often absent (69 and 62%). Only 42% discussed uncertainties.

Conclusion

Critical elements of SDM related to a woman’s values, goals and preferences were not explored when counseling about periviable delivery. Training in SDM is needed to advance communication skills for complex clinical decision-making.

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Acknowledgements

This work can be attributed to the Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, USA

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Authors and Affiliations

  1. Associate Professor of Obstetrics and Gynecology & Assistant Dean of Diversity Affairs, Department of Obstetrics & Gynecology, Indiana University School of Medicine, 410 W 10th Street, Indianapolis, IN, 46202, USA

    Brownsyne Tucker Edmonds

  2. Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA

    Fatima McKenzie & Janet Panoch

  3. Associate Professor of Clinical Obstetrics & Gynecology, Associate Department Head for Education and Faculty Development, & Director OB/GYN Residency Program, Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA

    Abigail Litwiller

  4. Assistant Dean for Medical Education and Academic Affairs & Associate Professor of Integrated Medical Science, Integrated Medical Science Department, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA

    Mark J. DiCorcia

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  1. Brownsyne Tucker Edmonds
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  2. Fatima McKenzie
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  3. Janet Panoch
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Correspondence to Brownsyne Tucker Edmonds.

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Tucker Edmonds, B., McKenzie, F., Panoch, J. et al. Evaluating shared decision-making in periviable counseling using objective structured clinical examinations. J Perinatol 39, 857–865 (2019). https://doi.org/10.1038/s41372-019-0366-1

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