A randomised controlled trial of a decision-aid leaflet to facilitate women's choice between pregnancy termination methods

Abstract

Objective: To evaluate the effectiveness of a decision aid to help women choose between surgical and medical methods of pregnancy termination.

Design: A randomised controlled trial comparing a decision-aid leaflet about termination methods with a control leaflet about contraception.

Setting: An NHS regional centre for pregnancy termination.

Sample: All women less than 9 weeks of gestation referred for termination of pregnancy over 7 months in 2002.

Methods: Participants were given an envelope containing either the decision-aid or the control leaflet prior to choosing between medical and surgical termination methods and completed two questionnaires, one immediately after this consultation and another after the termination procedure.

Main outcome measures: Choice of termination method; measures of effective decision making including risk perception, attitudes and knowledge of both the medical and surgical methods; decisional conflict; anxiety and usefulness of the leaflet.

Results: Three hundred and twenty-eight women participated. There was no difference in the method chosen between the groups (60/162 women in the decision-aided group chose a medical method versus 54/164 women in the control group (OR 1.2; 95% CI 0.76-1.9). Women in the decision-aided group had higher knowledge and lower risk-perception scores about both methods, more positive attitudes about the medical method, lower decisional conflict, more stable evaluations of the decision information over time and higher perceived usefulness of information ratings. Anxiety was high but unrelated to leaflet type.

Conclusions: Women made more informed decisions when provided with an evidence-based decision-aid leaflet preceding a routine consultation about choices of termination method.