The quality of tubal sterilization decision-making quality is significantly improved by a web-based decision aid, according to a recent study published in JAMA Network Open.
Takeaways
- Tubal sterilization remains a prevalent contraceptive choice among US women, particularly among socially disadvantaged groups, despite concerns of coercion and post-sterilization regret.
- The MyDecision aid, a web-based tool, was developed to address the need for informed decision-making among low-income patients considering tubal sterilization.
- A randomized clinical trial demonstrated that participants using the MyDecision aid exhibited significantly improved knowledge about tubal sterilization compared to those receiving usual care.
- The intervention group utilizing MyDecision reported a mean 22.6% increase in correctly answering questions about tubal sterilization, with notable improvements in understanding irreversibility and spontaneous untying of fallopian tubes.
- Participants in the intervention group also experienced a significant reduction in decisional conflict, particularly in the informed and values subscales, suggesting the efficacy of the MyDecision tool in enhancing decision-making quality.
Tubal sterilization is the most common method of contraception among women aged 15 to 49 years in the United States, with demand increasing following the Dobbs v Jackson Women’s Health Organization decision. Socially disadvantaged populations, such as marginalized racial and ethnic groups, are significantly more likely to use tubal sterilization.
These marginalized groups are often targeted by coercive sterilization practices and experience poststertilization regret, indicating a need for informed decision-making. However, data has indicated patients’ decision-making is often not well informed.
Investigators developed the MyDecision aid to improve decision making among low-income patients. A multisite, parallel-arm randomized clinical trial was conducted to evaluate the efficacy of MyDecision for sterilization decision quality.
Participants included pregnant women with Medicaid insurance scheduled for first- or second-trimester parallel appointment. Patients’ preferences for in-person or remote screening, consent, baseline assessment, intervention, and time 1 (T1) assessment were accommodated.
Self-reported race and ethnicity data was collected to ensure diversity. Patients were eligible if they were under 24 weeks pregnant, were considering tubal sterilization after delivery, were enrolled in or eligible for Medicaid, spoke English or Spanish, and were aged 21 to 45 years.
Patients were randomized 1:1 to either an intervention or control group. In the intervention arm, patients independently completed the web-based MyDecision aid. The aid provided information about tubal sterilization procedures through written, audio, and video formats.
Alongside providing information, the MyDecision aid compared contraceptive options using an interactive table and had values-clarifying exercises, knowledge-checks, and a summary report. Patients in the control group received usual care only.
T1 assessments were performed after completing the decision aid in this group, and after a baseline assessment in the control group. A time 2 assessment was performed over telephone during the third trimester and at 3 months postpartum.
Tubal sterilization knowledge was the first primary outcome, determined by responses to true-false items relating to tubal sterilization. Participant decisional conflict was the second primary outcome, determined using the Decision Conflict Scale.
There were 350 participants included in the final analysis, aged a mean 29.7 years and with a mean gestational age of 16.1 weeks. Of participants, 26% were Black, 26% Hispanic, 39.1% White, 4% multiracial, and 4% other race or ethnicity. A mean time of 14.36 for using the decision aid was reported in English and 18.45 minutes in Spanish.
In the intervention group, the mean percentage of 10 items about tubal sterilization answered correctly was 76.5%, vs 55.6% in the control group. This indicated a mean 22.6% improved knowledge in the intervention group.
The most significantly different means were for correctly answering that tubal sterilization is not easily reversible, at 90.1% in the intervention group and 39.3% in the control group, and that tubes do not spontaneously become untied at 86.6% vs 33.7%, respectively.
Additionally, decisional conflict was significantly decreased in the intervention group, with a mean score of 12.7 points vs 18.7 points in the control group. The informed subscale and values subscale had the greatest difference, at 14.8 points vs 25.4 points, respectively, and 10.3 vs 17, respectively.
These results indicated efficacy from the MyDecision tool in improving decision-making quality. Investigators concluded the intervention can be widely implemented to improve counseling on permanent contraception.
Reference
Borrero S, Mosley EA, Wu M, et al. A decision aid to support tubal sterilization decision-making among pregnant women: The MyDecision/MiDecisión randomized clinical trial. JAMA Netw Open. 2024;7(3):e242215. doi:10.1001/jamanetworkopen.2024.2215
