Women's Health

Numeric tool helps women determine their birthing preferences after cesareans

A comparison of two computer-based decision tools shows that a graphic-numeric tool provided more consistent responses than a text-based tool in helping women determine if they were comfortable attempting a vaginal birth after cesarean, a new study finds. Using the tools, 96 women who underwent cesareans previously made a series of paired comparisons to determine how they viewed the importance of four decision criteria: avoiding harm to the baby, avoiding side effects for the mother, avoiding risk to future pregnancies, and having a good delivery experience. The tools were not designed to make a final decision for the patient but to help the woman understand her priorities for her next childbirth experience.

The graphic-numeric tool was a sliding bar that displayed a numeric value as women slid a bar between two decision criteria. Each woman slid the bar closest to the criterion that was more important to her or set the bar in the middle for two equally important criteria. The text-based tool had women choose between two criteria by selecting radio buttons with labels ranging from "equally important" to "extremely more important." Although both scales helped clarify the users' values, the women who used the graphic-numeric scale were more consistent in their answers.

Women placed the most priority on avoiding harm to their babies and the least priority on having a good delivery experience. The women using the graphic-numeric tool may have had more consistent answers because the tool translated text into a number and allowed them to show how they were leaning.

The authors suggest that women who used the text-based tool may have felt pressured to choose a certain radio button over another because they feared they would be judged unfavorably if they expressed any preference for the other criterion. These results may help researchers who design future decision aids for patients who are facing medical decisions, but who may be hesitant in sharing their preferences for fear of being judged. This study was funded in part by the Agency for Healthcare Research and Quality (HS13959, HS15321, HS11338).

See "Patients were more consistent in randomized trial at prioritizing childbirth preferences using graphic-numeric than verbal formats," by Karen B. Eden, Ph.D., James G. Dolan, M.D., Jeanne-Marie Guise, M.D. M.P.H., and others in the April 2009 Journal of Clinical Epidemiology 62, pp. 415-424.

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