***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives Patient decision aids can be used to support pregnant women engaging in shared decisions , but little is known about their effects in obstetrics . The authors aim ed to evaluate the effects of patient decision aids design ed for pregnant women on clinical and psychosocial outcomes . Design Systematic review . Data on all outcomes were extracted and summarised . All studies were critically appraised for potential sources of bias and , when possible to obtain , the reported decision aids were evaluated . Meta- analysis was not possible due to the heterogeneity of outcomes in primary studies and the small number of studies . Data sources Electronic search es were performed using Medline , Embase , the Cochrane Library and Medion data bases from inception until December 2010 . Reference lists of all included articles were also examined and key experts contacted . Eligibility criteria for selecting studies Eligibility criteria included r and omised controlled trials , which reported on patient decision  aids for women facing any treatment decision in pregnancy published in English . Studies evaluating health education material that did not address women 's values and preferences were excluded . Results Patient decision aids have been developed for decisions about prenatal testing , vaginal birth after Caesarean section , external cephalic version and labour analgesia . Use of decision aids is associated with a number of positive effects including reduced anxiety , lower decisional conflict , improved knowledge , improved satisfaction and increased perception of having made an informed choice . Conclusions Patient decision aids have the potential to improve obstetric care . However , currently the evidence base is limited by the small number of studies , the quality of the studies and because they involved heterogeneous decision aids , patient groups and outcomes OBJECTIVE To develop and pilot two computer-based decision aids to assist women with decision-making about mode of delivery after a previous caesarean section ( CS ) , which could then be evaluated in a r and omized-controlled trial . BACKGROUND Women with a previous CS are faced with a decision between repeat elective CS and vaginal birth after caesarean . Research has shown that women may benefit from access to comprehensive information about the risks and benefits of the delivery options . DESIGN A qualitative pilot study of two novel decision aids , an information program and a decision analysis program , which were developed by a multidisciplinary research team . PARTICIPANTS AND SETTING 15 women who had recently given birth and had previously had a CS and 11 pregnant women with a previous CS , recruited from two UK hospitals . Women were interviewed and observed using the decision aids . RESULTS Participants found both decision aids useful and informative . Most liked the computer-based format . Participants found the utility assessment of the decision analysis program acceptable although some had difficulty completing the tasks required . Following the pilot study improvements were made to exp and the program content , the decision analysis program was accompanied by a training session and a website version of the information program was developed to allow repeat access . CONCLUSIONS This pilot study was an essential step in the design of the decision aids and in establishing their acceptability and feasibility . In general , participating women viewed the decision aids as a welcome addition to routine antenatal care . A r and omized trial has been conducted to establish the effectiveness and cost-effectiveness of the decision aids Background Caesarean section ( CS ) has become an increasingly common method of delivery worldwide , rising in the UK from 9 % of deliveries in 1980 to over 21 % 2001 . This increase , and the question of whether CS should be available to women on request , has been the subject of considerable debate , and national reports and guidelines have specifically highlighted the importance of patient choice in the decision making process . For women who have already experienced CS , the UK National Institute of Clinical Excellence recommends that the decision should consider maternal preferences and priorities in addition to general discussion of the overall risks and benefits of CS . Decision aids for many different medical treatment and screening decisions have been developed and evaluated , but there is relatively little evidence for the use of decision aids for choice of mode of delivery among women with a previous CS . The aim of the study is to evaluate two interventions to assist decision making about mode of delivery among pregnant women with one previous CS . Methods / design Women with one previous CS are recruited to the trial during their booking visit at approximately 12–20 weeks ' gestation in participating maternity units in Bristol , Weston and Dundee . Using central r and omisation , women are allocated to one of three arms : information programme and website ; decision analysis ; usual care . Both interventions are computer-based , and are design ed to provide women with detailed information about the potential outcomes for both mother and baby of planned vaginal delivery , planned CS and emergency CS . The decision analysis intervention additionally provides a recommended ' preferred option ' based on maximised expected utility . There are two primary outcomes ( decisional conflict and actual mode of delivery ) , and five secondary outcomes ( anxiety , knowledge , perceptions of shared decision making ; satisfaction with decision making process , proportion of women attempting vaginal delivery ) . Primary follow up for the question naire measures is at 36–37 weeks ' gestation , and a total of 660 women will be recruited to the study . The primary intention-to-treat analyses will comprise three pair-wise comparisons between decision analysis , information and usual care groups , for each of the two primary outcomes . A qualitative study will investigate women 's experiences of the decision making in more depth , and an economic evaluation from the perspective of the NHS will be conducted . Discussion Provision of information to women facing this decision appears variable . The DiAMOND study aims to inform best practice in this area by evaluating the effectiveness of two interventions design ed to aid decision making OBJECTIVE We developed an evidence -based decision aid to help women with a prior cesarean to prioritize their childbirth preferences related to a future birth . Because there was uncertainty about which scale format would assist the patients in being most consistent in prioritizing preferences in a multiattribute decision model , we compared a graphic-numeric scale with a text-anchored scale . STUDY DESIGN AND SETTING Ninety-six postnatal women with a prior cesarean were r and omized to use 1 of 2  preference scale formats in a computerized childbirth decision aid . We measured the level of inconsistency ( intransitivity ) when patients prioritized their childbirth preferences and clarity of values before and after using the decision aid . RESULTS When the trade-offs involved risk , women were more consistent when using graphic-numeric than text-anchored formats ( P=0.015 ) . They prioritized safety to their baby as 4 times more important than any other decision factor including safety to self . Both groups reduced unclear childbirth values over time ( P<0.001 ) . Women who over-used the extreme ends of the scale when evaluating risk were more likely to be inconsistent ( P<0.001 ) . CONCLUSION Patients were more consistent in making trade-offs involving risk using graphic-numeric formats than text-anchored formats to measure patient preferences BACKGROUND Women with one previous caesarean section must decide which mode of delivery they would prefer in their next pregnancy . This involves a choice between attempted vaginal birth and elective caesarean section . OBJECTIVE To explore women 's mode of delivery preferences and the values placed on the outcomes of decision making . Greater insight into these issues could benefit both clinical care and future research . DESIGN Observational study using longitudinal data collected within a r and omized controlled trial . SETTING AND PARTICIPANTS Seven hundred and forty-two women with one previous caesarean section recruited at four antenatal clinics in South West Engl and and Scotl and . MAIN OUTCOME MEASURES Mode of delivery preference recorded at 19 and 37 weeks ' gestation and visual analogue scale ratings of health and delivery outcomes . RESULTS Comparison of mid and late pregnancy preferences and actual mode of delivery shows that 57 % of women hold the same mode of delivery preferences at both times and 65 % of women actually have the birth they prefer . The visual analogue scale ratings show variation in the way women value the outcomes of the decision . DISCUSSION AND CONCLUSIONS Underst and ing the way women 's mode of delivery preferences change , how these relate to actual mode of delivery and how women value the outcomes of their decision will be beneficial to health professionals who wish to support women both during pregnancy and after birth . In addition , the visual analogue scale ratings provide evidence that may improve the development of population -level and economic models of decision making This paper presents the development and pilot testing of an evidence -based decision-aid for pregnant women who have experienced previous caesarean section and who are considering options for birth in a subsequent pregnancy . The Ottawa Decision Support Framework ( DSF ) has been utilised and modified in the development of a tailored booklet entitled " Birth Choices : What is best for you ... vaginal or caesarean birth ? " Development included a review by women who had experienced previous caesarean birth as well as obstetric , midwifery and educational experts . The booklet was also review ed for acceptability by 21 pregnant women who were facing this birth decision . Pre- and post-booklet preferences for birth were elicited and compared to actual birth outcomes . This decision-aid shows promise in facilitating informed decision-making in pregnancy . It is currently undergoing an evaluation in a multi-centre r and omised controlled trial BACKGROUND Decision-making about mode of birth after a cesarean delivery presents challenges to women and their caregivers and requires a balance of risks and benefits according to individual circumstances . The study objective was to determine whether a decision-aid for women who have experienced previous cesarean birth facilitates informed decision-making about birth options during a subsequent pregnancy . METHOD A prospect i ve multicenter r and omized controlled trial of 227 pregnant women was conducted within 3 prenatal clinics and 3 private obstetric practice s in New South Wales , Australia . Women with 1 previous cesarean section and medically eligible for trial of vaginal birth were recruited at 12 to 18 weeks ' gestation ; 115 were r and omized to the intervention group and 112 to the control group . A decision-aid booklet describing risks and benefits of elective repeat cesarean section and trial of labor was given to intervention group women at 28 weeks ' gestation . Main outcome measures included level of knowledge , decisional conflict score , women 's preference for mode of birth , and recorded mode of birth . RESULTS Women who received the decision-aid demonstrated a significantly greater increase in mean knowledge scores than the control group ( increasing by 2.17 vs 0.42 points on a 15-point scale ) ( p < 0.001 , 95 % CI for difference = 1.15 - 2.35 ) . The intervention group demonstrated a reduction in decisional conflict score ( p < 0.05 ) . The decision-aid did not significantly affect the rate of uptake of trial of labor or elective repeat cesarean section . Preferences expressed at 36 weeks were not consistent with actual birth outcomes for many women . CONCLUSION A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict . However , little evidence suggested that this process led to an informed choice . Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice . Further work needs to examine ways to enhance women 's power in decision-making within the doctor-patient relationship OBJECTIVE To compare intensive and conventional therapy for  severe fear of childbirth . METHODS In Finl and , 176 women who had fear of childbirth were r and omly assigned at the 26th gestational week to have either intensive therapy ( mean 3.8 ± 1.0 sessions with obstetrician and one with midwife ) or conventional therapy  ( mean 2.0 ± 0.6 sessions ) , with follow‐up 3 months postpartum . Pregnancy‐related anxiety and concerns , satisfaction with childbirth , and puerperal depression were assessed with specific question naires . Power analysis , based on previous studies , showed that 74 women per group were necessary to show a 50 % reduction in cesarean rates . RESULTS Birth‐related concerns decreased in the intensive therapy group but increased in the conventional therapy group ( linear interaction between the group and birth‐concerns P = .022 ) . Labor was shorter in the intensive therapy group ( mean ± st and ard deviation 6.8 ± 3.8 hours ) compared with the conventional group ( 8.5 ± 4.8 hours , P = .039 ) . After intervention , 62 % of those originally requesting a cesarean ( n = 117 ) chose to deliver vaginally , equally in both groups . Cesarean was more frequent for those who refused to fill in the question naires than for those who completed them ( 57 % compared with 27 % , P = .001 ) . In the log‐linear model , parous women who had conventional therapy and refused to fill in the question naires chose a cesarean more often than expected ( st and ardized residual 2.54 , P = .011 ) . There were no differences between groups in satisfaction with childbirth or in puerperal depression . CONCLUSION Both kinds of therapy reduced unnecessary cesareans , more so in nulliparous and well‐motivated women . With intensive therapy , pregnancy‐ and birth‐related anxiety and concerns were reduced , and labors were shorter Objective To develop a scoring system to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarian delivery using factors known at the time of hospital admission . Methods Trial of labor was attempted in 5022 patients who were assigned r and omly to score derivation and score testing groups .  Multivariate logistic regression modeling was used in the score derivation group to develop a predictive scoring system for vaginal birth . The scoring system was then applied to the testing group to evaluate its predictive ability . Results Five variables significantly affected the mode of birth and were incorporated into a weighted scoring system . Rates of successful vaginal birth after cesarean ranged from 49 % in patients scoring 0–2 to 95 % in patients scoring 8–10 . Increasing score was associated linearly with increasing probability of vaginal birth after cesarean . Conclusion increasing scores correlate with increasing probability of vaginal birth after cesarean . The admission vaginal birth after cesarean scoring system may be useful in counseling patients regarding the option of vaginal birth or repeat cesarean delivery . This information could be particularly valuable for the patient who opts for trial of labor but has second thoughts about 
    Output:
    
While women liked the decision support there was concern among health professionals about their impact on their time and workload .
Evidence is limited to independent and mediated decision supports .