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Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study

BACKGROUND: Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to und...

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Autores principales: Doraiswamy, Sathyanarayanan, Billah, Sk Masum, Karim, Farhana, Siraj, Md Shahjahan, Buckingham, Alan, Kingdon, Carol
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871368/
https://www.ncbi.nlm.nih.gov/pubmed/33563303
http://dx.doi.org/10.1186/s12978-021-01098-8
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author Doraiswamy, Sathyanarayanan
Billah, Sk Masum
Karim, Farhana
Siraj, Md Shahjahan
Buckingham, Alan
Kingdon, Carol
author_facet Doraiswamy, Sathyanarayanan
Billah, Sk Masum
Karim, Farhana
Siraj, Md Shahjahan
Buckingham, Alan
Kingdon, Carol
author_sort Doraiswamy, Sathyanarayanan
collection PubMed
description BACKGROUND: Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician–patient communication leading to informed-consent for the operation. METHODS: We conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥ 80 births every month; and for physicians, was that they had performed CSs. Women aged ≥ 18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis. RESULTS: In total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician–patient communication in the context of labour situations, the OPTION5 mean scores were low (5–25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication. CONCLUSIONS: Insufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too.
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spelling pubmed-78713682021-02-09 Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study Doraiswamy, Sathyanarayanan Billah, Sk Masum Karim, Farhana Siraj, Md Shahjahan Buckingham, Alan Kingdon, Carol Reprod Health Research BACKGROUND: Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician–patient communication leading to informed-consent for the operation. METHODS: We conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥ 80 births every month; and for physicians, was that they had performed CSs. Women aged ≥ 18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis. RESULTS: In total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician–patient communication in the context of labour situations, the OPTION5 mean scores were low (5–25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication. CONCLUSIONS: Insufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too. BioMed Central 2021-02-09 /pmc/articles/PMC7871368/ /pubmed/33563303 http://dx.doi.org/10.1186/s12978-021-01098-8 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Doraiswamy, Sathyanarayanan
Billah, Sk Masum
Karim, Farhana
Siraj, Md Shahjahan
Buckingham, Alan
Kingdon, Carol
Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study
title Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study
title_full Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study
title_fullStr Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study
title_full_unstemmed Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study
title_short Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study
title_sort physician–patient communication in decision-making about caesarean sections in eight district hospitals in bangladesh: a mixed-method study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871368/
https://www.ncbi.nlm.nih.gov/pubmed/33563303
http://dx.doi.org/10.1186/s12978-021-01098-8
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