Decisions, choice and shared decision making in antenatal clinics: An observational study

• SDM and choice have been prioritised in UK maternity services.
• However, no choice was offered in 75% of antenatal decisions.
• Choice was associated with the decision made, consultation length and doctor seniority.
• Without choice, patients and healthcare professionals can’t truly share decisions.
• We need to understand the factors that impact choice availability.

ObjectiveThe 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.MethodsCross-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.Results585 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.ConclusionsWithout a choice, it will be challenging for a patient and their healthcare profession to truly share decisions.Practice ImplicationsIf 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.