Moving Towards Patient Centered Care: Women's Decisions, Perceptions, and Experience of the Induction of Labor Process.

Abstract

Despite evidence that undergoing elective induction of labor can increase health risks to mothers and their infants and increase healthcare costs, the incidence continues to rise. Patient preferences and provider practice style are possible causative factors to explain this increase. However, scientific studies are absent that demonstrate this link. How women use evidence based information to make decisions about induction of labor has also not been fully explored. Currently, most implementation science models do not identify the patient as an important element in translation of evidence into practice.

To better understand factors that influence the practice of induction of labor from women’s perspectives, a qualitative investigation using grounded theory methodology was conducted. Women were interviewed pre- and post- induction and medical record data was abstracted noting medical indications for induction. Analysis of the interviews was conducted using constant comparison to identify codes, categories, and themes. Through this process the complex intersection between women, their provider, and the application of evidence based care in clinical practice was explored.

Five major themes from the pre-induction interview that influenced women’s decisions for induction of labor were identified including safety of baby, women’s trust in their provider, relief of discomfort and/or anxiety, diminish potential or actual risk, and lack of informed decision making. Five major themes representing women’s experiences of the labor induction process were identified from the post-induction interview including lack of informed decision making/limited patient activation, induction as part of checklist, women’s trust in their provider, happy with induction of labor decision, and opportunities to improve the experience of the induction of labor process. Overall, lack of informed decision making was cited as a barrier to optimal care in the experience of induction of labor. Application of these findings to an adapted implementation science model resulted in the development of the Evidence Informed Decision Making Through Engagement Model which identifies women as active agents in translation of evidence into practice. This study has important implications for patient centered outcomes research, requiring the inclusion of women and the salient concepts of care and evaluation that they identify are integrated into translation science.