title: Shared decision-making and decision support: their role in obstetrics and gynecology.
abstract: OBJECTIVE
  To discuss the role for shared decision-making in obstetrics/gynecology and to review evidence on the impact of decision aids on reproductive health decision-making.
  
  
  RESULTS
  Among the 155 studies included in a 2014 Cochrane review of decision aids, 31 (29%) addressed reproductive health decisions. Although the majority did not show evidence of an effect on treatment choice, there was a greater uptake of mammography in selected groups of women exposed to decision aids compared with usual care; and a statistically significant reduction in the uptake of hormone replacement therapy among detailed decision aid users compared with simple decision aid users. Studies also found an effect on patient-centered outcomes of care, such as medication adherence, quality-of-life measures, and anxiety scores. In maternity care, only decision analysis tools affected final treatment choice, and patient-directed aids yielded no difference in planned mode of birth after cesarean.
  
  
  CONCLUSIONS
  There is untapped potential for obstetricians/gynecologists to optimize decision support for reproductive health decisions. Given the limited evidence-base guiding practice, the preference-sensitive nature of reproductive health decisions, and the increase in policy efforts and financial incentives to optimize patients' satisfaction, it is increasingly important for obstetricians/gynecologists to appreciate the role of shared decision-making and decision support in providing patient-centered reproductive healthcare.
authors.affiliation: Indiana University School of Medicine, Department of Obstetrics and Gynecology, Indianapolis, Indiana, USA.
authors.forename: Brownsyne
authors.initials: B
authors.lastname: Tucker Edmonds
mesh_terms: D001007:Anxiety / Q000517:prevention & control; D001294:Attitude to Health; D003657:Decision Making; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005260:Female; D006176:Gynecology / Q000639:trends; D006801:Humans; D055118:Medication Adherence; D009774:Obstetrics / Q000639:trends; D057240:Patient Preference; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011247:Pregnancy; D011295:Prenatal Care / Q000639:trends; D011787:Quality of Health Care; D011788:Quality of Life; D034121:Reproductive Health Services / Q000639:trends; D000078329:Workforce