title: Decisions, choice and shared decision making in antenatal clinics: An observational study.
abstract: OBJECTIVE
  The UK Government has prioritised shared decision making (SDM) and choice in maternity services, but no studies have explored the breadth of antenatal decisions or the feasibility of this aspiration. This study aimed to describe the decisions made, investigate the factors associated with choice and explore SDM practice.
  
  
  METHODS
  Cross-sectional audio-recording of consultations in a UK district general hospital. Multi-level regression models were used to investigate associations between choice and doctor, patient, consultation and decision variables.
  
  
  RESULTS
  585 decisions were documented with a mean of 3.0 (SD 1.5) per consultation. No choice was offered in 75% of decisions. Choice was associated with the decision topic, consultation length, Royal College membership status and presence on the specialist register.
  
  
  CONCLUSIONS
  Without a choice, it will be challenging for a patient and their healthcare profession to truly share decisions.
  
  
  CONCLUSIONS
  If universal SDM is the aim, then further work is required to understand the factors impacting choice availability and SDM, while engaging and supporting healthcare professionals to offer options and share decisions with patients.
authors.affiliation: School of Acute Care Common Stem, Severn Deanery, Bristol, UK. Electronic address: FGarrard@doctors.org.uk.
authors.forename: Francesca
authors.initials: F
authors.lastname: Garrard
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ridd
authors.affiliation: The Great Western Hospital, Swindon, UK.
authors.forename: Harini
authors.initials: H
authors.lastname: Narayan
authors.affiliation: Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011247:Pregnancy; D011295:Prenatal Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Antenatal; Choice; Decisions; Maternity; Obstetrics; Option; Shared decision making