Perinatal decision making as a decision scientist

Abstract

Decision science offers an opportunity to understand perspectives on perinatal decision making, from understanding risk and uncertainty, to decision-maker preferences. Here, I describe a specific instance of making perinatal medical decisions from the perspective of a decision scientist and a parent navigating clinical uncertainty. I explain how clinical encounters did and did not provide the required information needed to make choices informed by decision science methods and results. My purpose is to provide modest inspiration to those working at the intersection of decision science and perinatal/neonatal medicine about problems their disciplines could solve to improve the experience of decision-makers.Years before I would have children of my own, I read Detlof von Winterfeldt's account of his wife deciding whether to undergo a procedure to try and move her nearly-term fetus out of the breech position (1). He describes his analysis of the problem, informed by his wife's values and preferences. That analysis revealed that the best decision was unambiguously not to do the procedure, despite the opposing view of his wife's physician, who had not thought through what the evidence meant for them, nor considered von Winterfeldt's wife's preferences. The account is an illustrative description of the decision-analytic method, showing how science, beliefs, and values can be integrated into a framework to guide medical (and other) decision making.