title: Patients were more consistent in randomized trial at prioritizing childbirth preferences using graphic-numeric than verbal formats.
abstract: OBJECTIVE
  We developed an evidence-based decision aid to help women with a prior cesarean to prioritize their childbirth preferences related to a future birth. Because there was uncertainty about which scale format would assist the patients in being most consistent in prioritizing preferences in a multiattribute decision model, we compared a graphic-numeric scale with a text-anchored scale.
  
  
  METHODS
  Ninety-six postnatal women with a prior cesarean were randomized to use 1 of 2 preference scale formats in a computerized childbirth decision aid. We measured the level of inconsistency (intransitivity) when patients prioritized their childbirth preferences and clarity of values before and after using the decision aid.
  
  
  RESULTS
  When the trade-offs involved risk, women were more consistent when using graphic-numeric than text-anchored formats (P=0.015). They prioritized safety to their baby as 4 times more important than any other decision factor including safety to self. Both groups reduced unclear childbirth values over time (P<0.001). Women who over-used the extreme ends of the scale when evaluating risk were more likely to be inconsistent (P<0.001).
  
  
  CONCLUSIONS
  Patients were more consistent in making trade-offs involving risk using graphic-numeric formats than text-anchored formats to measure patient preferences.
authors.affiliation: Oregon Health & Science University, Department of Medical Informatics & Clinical Epidemiology, Portland, OR, USA. edenk@ohsu.edu
authors.forename: Karen B
authors.initials: KB
authors.lastname: Eden
authors.forename: James G
authors.initials: JG
authors.lastname: Dolan
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Perrin
authors.forename: Dundar
authors.initials: D
authors.lastname: Kocaoglu
authors.forename: Nicholas
authors.initials: N
authors.lastname: Anderson
authors.forename: James
authors.initials: J
authors.lastname: Case
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D017604:Cesarean Section, Repeat / Q000523:psychology*; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D040261:Harm Reduction; D006801:Humans; D017060:Patient Satisfaction; D011247:Pregnancy; D016064:Vaginal Birth after Cesarean / Q000523:psychology*; D055815:Young Adult