title: Is documentation of TOLAC counseling a good measure of quality of care?
abstract: OBJECTIVE
  The objective of this study is to determine whether chart documentation of patient counseling on trial of labor after cesarean (TOLAC) during prenatal care is associated with patient knowledge of risks and benefits of TOLAC and repeat cesarean delivery (RCD).
  
  
  METHODS
  Prenatal patients eligible for TOLAC completed a questionnaire that assessed their knowledge of basic maternal and neonatal risks and benefits of TOLAC versus planned repeat cesarean delivery. Patient electronic medical records were reviewed for documentation of TOLAC counseling. Women were included at both early and late time points in pregnancy to include those who both had and had not undergone counseling.
  
  
  RESULTS
  Patients with documented completed TOLAC counseling did not perform better on the knowledge survey. Patients who had documentation of counseling on specific subjects such as TOLAC success rates, risk of uterine rupture, and downstream health risks of cesarean section were no more likely to answer questions on these topics correctly than patients without counseling. However, patients with documented completed counseling generally felt that they were well informed.
  
  
  CONCLUSIONS
  Chart documentation of TOLAC counseling was not correlated with patient knowledge. Patients may not be gaining the knowledge from counseling that providers believe is important for informed decision making.
authors.affiliation: a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University Medical Center , New York , NY , USA and.
authors.forename: Alexander Michael
authors.initials: AM
authors.lastname: Friedman
authors.affiliation: b Department of Obstetrics and Gynecology , University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program , Philadelphia , PA , USA.
authors.forename: Sindhu K
authors.initials: SK
authors.lastname: Srinivas
mesh_terms: D000328:Adult; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010353:Patient Education as Topic; D011247:Pregnancy; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D014219:Trial of Labor
keywords: Care quality; TOLAC counseling; quality metric