title: Decision aids to improve informed decision-making in pregnancy care: a systematic review.
abstract: BACKGROUND
  Rapid development in health care has resulted in an increasing number of screening and treatment options. Consequently, there is an urgency to provide people with relevant information about benefits and risks of healthcare options in an unbiased way. Decision aids help people to make decisions by providing unbiased non-directive research evidence about all treatment options.
  
  
  OBJECTIVE
  To determine the effectiveness of decision aids to improve informed decision making in pregnancy care.
  
  
  METHODS
  We searched MEDLINE (1953-2011), EMBASE (1980-2011), CENTRAL (CENTRAL, the Cochrane Library; 2011, Issue 4), Psycinfo (1806-2011) and Research Registers of ongoing trials (www.clinicaltrials.gov, www.controlled-trials.com).
  
  
  METHODS
  We included randomised controlled trials comparing decision aids in addition to standard care. The study population needed to be pregnant women making actual decisions concerning their pregnancy.
  
  
  METHODS
  Two independent researchers extracted data on quality of the randomised controlled trial (GRADE criteria), quality of the decision aid (IPDAS criteria), and outcome measures. Data analysis was undertaken by assessing group differences at first follow up after the interventions.
  
  
  RESULTS
  Ten randomised controlled trials could be included. Pooled analyses showed that decision aids significantly increased knowledge, (weighted mean difference 11.06, 95% confidence interval 4.85-17.27), decreased decisional conflict scores (weighted mean difference -3.66, 95% confidence interval -6.65 to -0.68) and decreased anxiety (weighted mean difference -1.56, 95% confidence interval -2.75 to -0.43).
  
  
  CONCLUSIONS
  Our systematic review showed the positive effect of decision aids on informed decision making in pregnancy care. Future studies should focus on increasing the uptake of decision aids in clinical practice by identifying barriers and facilitators to implementation.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands. f.vlemmix@amc.uva.nl
authors.forename: F
authors.initials: F
authors.lastname: Vlemmix
authors.forename: J K
authors.initials: JK
authors.lastname: Warendorf
authors.forename: A N
authors.initials: AN
authors.lastname: Rosman
authors.forename: M
authors.initials: M
authors.lastname: Kok
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: J M
authors.initials: JM
authors.lastname: Morris
authors.forename: N
authors.initials: N
authors.lastname: Nassar
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D001007:Anxiety / Q000209:etiology; D002755:Choice Behavior; D002983:Clinical Competence / Q000592:standards; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D017060:Patient Satisfaction; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D011296:Prenatal Diagnosis / Q000379:methods; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic