Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2026
Navigating the Grey Zone: A Mixed-Methods Study to Evaluate a Decision Support Tool in the Society of Obstetricians and Gynaecologists of Canada Late Preterm Antenatal Corticosteroids Guideline.
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Liauw Jessica, Campbell Kayleigh S J, Ennis Madeleine, Cordingley Claire, Burrows Jason, Jain Venu, Soliman Nancy, Coll-Black Mary, Cohen Matthew, Skoll Amanda, Bansback Nick, Guyatt Gordon, Pulsifer Jodie, Shivananda Sandesh, Metcalfe Rebecca, Hutcheon Jennifer A
Аннотация
OBJECTIVES: This study aimed to evaluate the impact of integrating a decision support tool (DST) into the 2023 Society of Obstetricians and Gynaecologists of Canada (SOGC) Technical Update on Antenatal Corticosteroids at Late Preterm Gestation (340 to 366 weeks gestation) on the frequency and quality of patient counselling.
METHODS: Our mixed-methods study randomly assigned 6 Canadian hospitals within 3 provinces to receive the Technical Update alone (Guideline-only) or the Technical Update with integrated DST summarizing benefits and harms of late preterm antenatal corticosteroids (Guideline + DST). We administered questionnaires to persons with a late preterm live birth before and after guideline release to estimate the DST's effect on frequency and quality of counselling about late preterm antenatal corticosteroids using a difference-in-differences analysis. After guideline release, we interviewed obstetricians and used reflexive thematic analysis to explore factors influencing the DST's impact.
RESULTS: A total of 403 patients were eligible for counselling on late preterm antenatal corticosteroids. The DST had no apparent effect on counselling frequency (Guideline + DST: 11.1% before guideline release vs. 10.6% after; Guideline-only: 9.7% vs. 9.2%; difference-in-differences -0.5% [95% CI -12.0 to 11.0]) or quality (satisfaction with communication, difference-in-differences 0 points [-1.30 to 1.30]; confidence in decision, -0.5 points [-2.20 to 1.20]). Obstetricians (n = 28) described 3 themes influencing the DST's impact: (1) limitations in accessing the DST; (2) improving knowledge with variable practice change; and (3) uncertain relevance of benefits and harms.
CONCLUSIONS: Integrating a DST into the Society of Obstetricians and Gynaecologists of Canada Technical Update did not increase the frequency or quality of patient-reported counselling, but some obstetricians reported improved knowledge of benefits and harms of late preterm antenatal corticosteroids.
METHODS: Our mixed-methods study randomly assigned 6 Canadian hospitals within 3 provinces to receive the Technical Update alone (Guideline-only) or the Technical Update with integrated DST summarizing benefits and harms of late preterm antenatal corticosteroids (Guideline + DST). We administered questionnaires to persons with a late preterm live birth before and after guideline release to estimate the DST's effect on frequency and quality of counselling about late preterm antenatal corticosteroids using a difference-in-differences analysis. After guideline release, we interviewed obstetricians and used reflexive thematic analysis to explore factors influencing the DST's impact.
RESULTS: A total of 403 patients were eligible for counselling on late preterm antenatal corticosteroids. The DST had no apparent effect on counselling frequency (Guideline + DST: 11.1% before guideline release vs. 10.6% after; Guideline-only: 9.7% vs. 9.2%; difference-in-differences -0.5% [95% CI -12.0 to 11.0]) or quality (satisfaction with communication, difference-in-differences 0 points [-1.30 to 1.30]; confidence in decision, -0.5 points [-2.20 to 1.20]). Obstetricians (n = 28) described 3 themes influencing the DST's impact: (1) limitations in accessing the DST; (2) improving knowledge with variable practice change; and (3) uncertain relevance of benefits and harms.
CONCLUSIONS: Integrating a DST into the Society of Obstetricians and Gynaecologists of Canada Technical Update did not increase the frequency or quality of patient-reported counselling, but some obstetricians reported improved knowledge of benefits and harms of late preterm antenatal corticosteroids.