Helen White1, Victoria Hodgetts Morton2, Sarah J Stock3, Tina Lavender4. 1. The Division of Nursing, Midwifery and Social Work, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: helen.white@manchester.ac.uk. 2. The University of Birmingham, Institute of Metabolism and Systems Research, Edgbaston, Birmingham B15 2TT, United Kingdom. Electronic address: V.A.H.Morton@bham.ac.uk. 3. Wellcome Trust Clinical Career Development Fellow, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh EH16 4UX, United Kingdom. Electronic address: Sarah.Stock@ed.ac.uk. 4. The Division of Nursing, Midwifery and Social Work, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: Tina.Lavender@manchester.ac.uk.
Abstract
BACKGROUND: Minimising the risks of mortality, morbidities, and the costs associated with preterm birth is reliant on accurate prediction, appropriate decision-making and timely intervention. This study aimed to determine for the first time the decisional and informational requirements of women and clinicians during preterm labour diagnosis and intervention. A secondary objective was to explore their experiences. STUDY DESIGN: A qualitative, interpretive approach was used in three tertiary referral units in England and Scotland. Women with experience of or risk factors for preterm birth and clinicians with experience of caring for women in preterm labour took part in semi-structured interviews individually face-face or via telephone, or in a small focus-group. Data was analysed using a framework approach. RESULTS: Women and clinicians welcomed a more accurate tool for predicting preterm birth. Women wanted to be actively involved in their care, but desired different levels of control over decisions. Communication between women and clinicians influenced women's overall experiences and shaped clinicians' practice. Women found accessing care difficult, due to uncertainty about symptoms and gatekeepers to face-face care. The emotional impact of their experiences influenced family plans and subsequent pregnancies. Women's overall perception of their experience was influenced by their judgement of the care they received. CONCLUSIONS: Decision-making is complex and a tool to more accurately predict preterm birth than is currently available was valued. Further research is warranted to evaluate a tool in clinical practice and to improve services for women with symptoms of preterm labour attempting to gain access to face-face care. Trial Registration ISRCTN: 41598423 and CPMS:31277.
BACKGROUND: Minimising the risks of mortality, morbidities, and the costs associated with preterm birth is reliant on accurate prediction, appropriate decision-making and timely intervention. This study aimed to determine for the first time the decisional and informational requirements of women and clinicians during preterm labour diagnosis and intervention. A secondary objective was to explore their experiences. STUDY DESIGN: A qualitative, interpretive approach was used in three tertiary referral units in England and Scotland. Women with experience of or risk factors for preterm birth and clinicians with experience of caring for women in preterm labour took part in semi-structured interviews individually face-face or via telephone, or in a small focus-group. Data was analysed using a framework approach. RESULTS:Women and clinicians welcomed a more accurate tool for predicting preterm birth. Women wanted to be actively involved in their care, but desired different levels of control over decisions. Communication between women and clinicians influenced women's overall experiences and shaped clinicians' practice. Women found accessing care difficult, due to uncertainty about symptoms and gatekeepers to face-face care. The emotional impact of their experiences influenced family plans and subsequent pregnancies. Women's overall perception of their experience was influenced by their judgement of the care they received. CONCLUSIONS: Decision-making is complex and a tool to more accurately predict preterm birth than is currently available was valued. Further research is warranted to evaluate a tool in clinical practice and to improve services for women with symptoms of preterm labour attempting to gain access to face-face care. Trial Registration ISRCTN: 41598423 and CPMS:31277.
Authors: Kiki Ruhe; Agnes van den Hoogen; Tinka Bröring-Starre; Joke M Wielenga; Mirjam M van Weissenbruch Journal: Acta Paediatr Date: 2022-04-22 Impact factor: 4.056