Subjective risk vs. objective risk can lead to different post-cesarean birth decisions based on multiattribute modeling

  • Sharma P
  • Eden K
  • Guise J
 et al. 
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Abstract

Objective: To compare birth recommendations for pregnant women with a prior cesarean produced from a decision model using absolute risks vs. one using subjective interpretation of the same risks: (1) a multiattribute decision model based on patient prioritization of risks (subjective risk) and (2) a hybrid model that used absolute risks (objective risk). Study Design and Setting: The subjective risk multiattribute model used the Analytic Hierarchy Process to elicit priorities for maternal risks, neonatal risks, and the delivery experience from 96 postnatal women with a prior cesarean. The hybrid model combined the priorities for delivery experience obtained in the first model with the unadjusted absolute risk values. Results: The multiattribute model generated more recommendations for repeat cesarean delivery than the hybrid model: 73% vs. 18%, (P-value

Author-supplied keywords

  • Analytic Hierarchy Process
  • Childbirth
  • Decision tree
  • Risk communication
  • Shared decision making
  • VBAC

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Authors

  • James DolanUniversity of Rochester

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  • Poonam S. Sharma

  • Karen B. Eden

  • Jeanne Marie Guise

  • Holly B. Jimison

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