Risk assessment and decision making about in-labour transfer from rural maternity care::  a social judgement and signal detection analysis

Helen Cheyne, H; Len Dalgleish; Janet  Tucker; Fiona Kane; Ashalatha Shetty; Sarah McLeod; Catherine Niven

doi:10.1186/1472-6947-12-122

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgement and signal detection analysis

Helen Cheyne, H, Len Dalgleish, Janet Tucker, Fiona Kane, Ashalatha Shetty, Sarah McLeod, Catherine Niven

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

31 Citations (Scopus)

8 Downloads (Pure)

Abstract

The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making.
Methods
The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds.
Results
When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians.
Conclusions
Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making.

Original language	English
Article number	122
Number of pages	13
Journal	BMC Medical Informatics and Decision Making
Early online date	31 Oct 2012
DOIs	https://doi.org/10.1186/1472-6947-12-122
Publication status	Published - 31 Oct 2012

Bibliographical note

PMCID: PMC3536665

Thanks are due to the midwives and obstetricians who participated in this study. The study was funded by a research grant from the Scottish Government Chief Scientist’s Office ref CZH/4/417. Thanks also to Prof Brian Williams for his very helpful comments on the paper.

Authors’ contributions
HC conceived of the study, participated in its design, coordinated the study and wrote the manuscript. LD developed the study method, participated in the design of the study, performed the statistical analysis and wrote the study final report with HC. JT participated in the design of the study, analysis of data and helped to draft and revise the manuscript. FK organised the study, collected the data, contributed to the analysis and the drafting of the manuscript. AS contributed to the study design and the drafting of the manuscript, SMcL contributed to the study design and the drafting of the manuscript, CN contributed to the study design and the drafting of the manuscript. Where possible all authors read and approved the final manuscript.

Keywords

Decision making
Risk Assessment
Rural
Labor
Maternity care
Social judgement theory
signal detection theory (SDT)

Access to Document

10.1186/1472-6947-12-122Licence: CC BY

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis
© 2012 Cheyne et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 998 KBLicence: CC BY

Cite this

@article{c9e034ec640c4f548630a19bb8b3a964,

title = "Risk assessment and decision making about in-labour transfer from rural maternity care:: a social judgement and signal detection analysis",

abstract = "The importance of respecting women{\textquoteright}s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making.MethodsThe study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants{\textquoteright} ability to distinguish high and low risk cases and personal decision thresholds.ResultsWhen reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians.ConclusionsCurrently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making.",

keywords = "Decision making, Risk Assessment, Rural, Labor, Maternity care, Social judgement theory, signal detection theory (SDT)",

author = "{Cheyne, H}, Helen and Len Dalgleish and Janet Tucker and Fiona Kane and Ashalatha Shetty and Sarah McLeod and Catherine Niven",

note = "PMCID: PMC3536665 Thanks are due to the midwives and obstetricians who participated in this study. The study was funded by a research grant from the Scottish Government Chief Scientist{\textquoteright}s Office ref CZH/4/417. Thanks also to Prof Brian Williams for his very helpful comments on the paper. Authors{\textquoteright} contributions HC conceived of the study, participated in its design, coordinated the study and wrote the manuscript. LD developed the study method, participated in the design of the study, performed the statistical analysis and wrote the study final report with HC. JT participated in the design of the study, analysis of data and helped to draft and revise the manuscript. FK organised the study, collected the data, contributed to the analysis and the drafting of the manuscript. AS contributed to the study design and the drafting of the manuscript, SMcL contributed to the study design and the drafting of the manuscript, CN contributed to the study design and the drafting of the manuscript. Where possible all authors read and approved the final manuscript.",

year = "2012",

month = oct,

day = "31",

doi = "10.1186/1472-6947-12-122",

language = "English",

journal = "BMC Medical Informatics and Decision Making",

issn = "1472-6947",

publisher = "BioMed Central",

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TY - JOUR

T1 - Risk assessment and decision making about in-labour transfer from rural maternity care:

T2 - a social judgement and signal detection analysis

AU - Cheyne, H, Helen

AU - Dalgleish, Len

AU - Tucker, Janet

AU - Kane, Fiona

AU - Shetty, Ashalatha

AU - McLeod, Sarah

AU - Niven, Catherine

N1 - PMCID: PMC3536665 Thanks are due to the midwives and obstetricians who participated in this study. The study was funded by a research grant from the Scottish Government Chief Scientist’s Office ref CZH/4/417. Thanks also to Prof Brian Williams for his very helpful comments on the paper. Authors’ contributions HC conceived of the study, participated in its design, coordinated the study and wrote the manuscript. LD developed the study method, participated in the design of the study, performed the statistical analysis and wrote the study final report with HC. JT participated in the design of the study, analysis of data and helped to draft and revise the manuscript. FK organised the study, collected the data, contributed to the analysis and the drafting of the manuscript. AS contributed to the study design and the drafting of the manuscript, SMcL contributed to the study design and the drafting of the manuscript, CN contributed to the study design and the drafting of the manuscript. Where possible all authors read and approved the final manuscript.

PY - 2012/10/31

Y1 - 2012/10/31

N2 - The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making.MethodsThe study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds.ResultsWhen reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians.ConclusionsCurrently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making.

AB - The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making.MethodsThe study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds.ResultsWhen reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians.ConclusionsCurrently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making.

KW - Decision making

KW - Risk Assessment

KW - Rural

KW - Labor

KW - Maternity care

KW - Social judgement theory

KW - signal detection theory (SDT)

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DO - 10.1186/1472-6947-12-122

M3 - Article

SN - 1472-6947

JO - BMC Medical Informatics and Decision Making

JF - BMC Medical Informatics and Decision Making

M1 - 122

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