Semra Ozdemir1,2,3, Teresa Chen4, Chin Wen Tan4,5, Wei Han Melvin Wong1,2, Hon Sen Tan4,5, Eric Andrew Finkelstein1,2,3,6, Ban Leong Sng4,5. 1. Health Services and Systems Research, Duke-NUS Medical School, Singapore. 2. Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore. 3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore. 4. Duke-NUS Medical School, Singapore. 5. Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore. 6. Duke University Global Health Institute, Duke University, Durham, NC, USA.
Abstract
Objective: The objective was to investigate the extent to which treatment benefits, risks and costs affected parturients' preferences for labor analgesia. Methods: We recruited 248 healthy parturients prior to labor at an antenatal ward and administered a discrete choice experiment survey. Parturients were asked to choose among four hypothetical forms of labor analgesia: epidural analgesia, pethidine, Entonox and no analgesia, which were defined by: pain score, duration of second stage of labor, risks of instrumental delivery, back pain and permanent nerve injury, and out-of-pocket cost. We used mixed logit model to calculate the relative importance of each attribute (out of 100). Results: Parturients preferred receiving labor analgesia over not receiving analgesia and those who had positive past experience with epidural preferred epidural over other modalities. Out-of-pocket cost (28%), duration of second stage of labor (26%) and pain score following treatment (18%) were the most important attributes. Conclusion: Out-of-pocket cost was a major concern. Parturients prioritized having lower pain and shorter labor experience over risks associated with epidural analgesia. Parturients should be presented with realistic range of risks of side-effects so that they can decide how to balance risks against benefits and costs associated with child labor.
Objective: The objective was to investigate the extent to which treatment benefits, risks and costs affected parturients' preferences for labor analgesia. Methods: We recruited 248 healthy parturients prior to labor at an antenatal ward and administered a discrete choice experiment survey. Parturients were asked to choose among four hypothetical forms of labor analgesia: epidural analgesia, pethidine, Entonox and no analgesia, which were defined by: pain score, duration of second stage of labor, risks of instrumental delivery, back pain and permanent nerve injury, and out-of-pocket cost. We used mixed logit model to calculate the relative importance of each attribute (out of 100). Results: Parturients preferred receiving labor analgesia over not receiving analgesia and those who had positive past experience with epidural preferred epidural over other modalities. Out-of-pocket cost (28%), duration of second stage of labor (26%) and pain score following treatment (18%) were the most important attributes. Conclusion: Out-of-pocket cost was a major concern. Parturients prioritized having lower pain and shorter labor experience over risks associated with epidural analgesia. Parturients should be presented with realistic range of risks of side-effects so that they can decide how to balance risks against benefits and costs associated with child labor.
Authors: Elke M E Bos; Maartje E Schut; Marcel de Quelerij; Cor J Kalkman; Markus W Hollmann; Philipp Lirk Journal: Acta Anaesthesiol Scand Date: 2018-08-01 Impact factor: 2.105