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OBJECTIVES: The objective of this randomized, controlled study was to determine the usefulness of a decision aid on pre-donation of autologous blood before elective open heart surgery. METHODS: The decision aid (DA) group received a tape and booklet which described the options for peri-operative transfusion in detail. The no decision aid (NDA) group received information usually given to patients about autologous donation. RESULTS: A total of 120 patients were randomized. The DA group rated themselves better prepared for decision making and showed significant improvements in knowledge (p = 0.001) and realistic risk perceptions (p = 0.001). In both groups there was an increase in the proportion of patients choosing allogeneic blood between baseline and follow-up (p = 0.001). Patients in the DA group were significantly more satisfied with the amount of information they received, how they were treated and with the decision they made, than patients in the NDA group. CONCLUSION: The decision aid is useful in preparing patients for decision making. PRACTICE IMPLICATIONS: The next stage is to explore strategies to make it available to all appropriate patients.

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CONTEXT: Shared decision-making programs, or patient decision aids, have been developed for difficult decisions in which patients need to consider benefits versus risks. PRACTICE PATTERN EXAMINED: Decision aids currently used in practice in Ottawa, Ontario, Canada. DATA SOURCES: Published studies of patients faced with decisions about hormone therapy, prenatal testing, lung cancer treatments, and anticoagulation for atrial fibrillation; administrative data on distribution of decision aids; and a survey mailed to pulmonologists and surgeons. RESULTS: Although most patients considering health care options arrive for counseling with strong predispositions toward a particular option, some are uncertain about their choice and express the need for information, clarification of values, and advice about their options. Decision aids prepare patients for decision making by increasing their knowledge about expected outcomes and personal values. The aids are used in our local centers, and more than 6000 kits have been distributed in Canada, the United States, Europe, and Australia. They primarily affect the decisions of patients who are undecided at baseline and sometimes reduce the proportion of patients who choose more intensive options. CONCLUSION: The Ottawa patient decision aids assist patient decision making, particularly among those who are undecided.

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OBJECTIVE: To develop and evaluate a decision aid designed to prepare patients of advanced maternal age for counseling about prenatal diagnostic testing. SETTING: A regional genetics center. DESIGN: A before/after study. INTERVENTIONS: Participants used an audioguided workbook to learn about options and outcomes and to clarify personal risks, values, questions, and predispositions. SUBJECTS: 21 women of advanced maternal age and 17 spouses. MAIN OUTCOME MEASURES: Knowledge of prenatal testing alternatives, decisional conflict, level of anxiety, and acceptability of the decision aid. RESULTS: After using the decision aid, participants had significantly reduced decisional conflict (uncertainty) and a significant increase in knowledge. There was no effect on state or trait anxiety. More than three-quarters of participants were satisfied with the length, clarity, balance, and acceptability of the decision aid. CONCLUSIONS: The decision aid shows promise as a useful aid for preparing couples for counseling.

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OBJECTIVES: To determine the current status of electronic fetal monitoring (EFM) in Canadian teaching and nonteaching hospitals, to review the medical and nursing standards of practice for EFM and to determine the availability of EFM educational programs. DESIGN: National survey in 1989. PARTICIPANTS: The directors of nursing at the 737 hospitals providing obstetric care were sent a questionnaire and asked to have it completed by the most appropriate staff member. The response rate was 80.5% (593/737); 44 hospitals did not have deliveries in 1988 and were excluded. The remaining hospitals varied in size from 8 to 1800 (mean 162.1) beds and had 1 to 7500 (mean 617.1) births in 1988; 18.8% were teaching hospitals. RESULTS: Of the 549 hospitals 419 (76.3%) reported having at least 1 monitor (range 1 to 30; mean 2.6); the mean number of monitors per hospital was higher in the teaching hospitals than in the nonteaching hospitals (6.2 v. 1.7). Manitoba had the lowest mean number of monitors per hospital (1.1) and Ontario the highest (3.7). In 71.8% of the hospitals with monitors almost all of the obstetric patients were monitored at some point during labour. However, 21.6% of the hospitals with monitors had no policy on EFM practice. The availability of EFM educational programs for physicians and nurses varied according to hospital size, type and region. CONCLUSIONS: Most Canadian hospitals providing obstetric services have electronic fetal monitors and use them frequently. Although substantial research has questioned the benefits of EFM, further definitive research is required. In the meantime, a national committee should be established to develop multidisciplinary guidelines for intrapartum fetal assessment.

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Public health and hospital nurses have widespread contact with smokers; an effective smoking cessation program administered by nurses has tremendous potential. This study evaluated: 1) the effectiveness of the self-help cessation program, "Time to Quit"/"Moi aussi, j'écrase" (TTQ), provided on a one-to-one basis; and 2) a smoking cessation training program for baccalaureate nursing students. Nursing students recruited 307 smokers who were randomly assigned to receive one of two interventions. Control smokers received a list of community smoking cessation resources and experimental subjects received this list plus TTQ. Smoking self-reports and cotinine levels were obtained at baseline, six weeks and nine months. More smokers receiving TTQ had reduced at six weeks post-intervention, while there were no differences in quit or reduction rates at the nine-month follow-up. Students were positive about learning the techniques and their knowledge scores were significantly higher than those of non-participating students.

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Few students in health care disciplines are immunized against hepatitis B. In order to determine the immunization prevalence and identify the factors influencing the intentions of students to accept hepatitis B vaccine, we administered a questionnaire to 435 university and community college students in health care disciplines in Ottawa where there was no hepatitis B immunization program. We found that only 14% of the students had been immunized. There was significant variability among student groups in their perceptions of the risk of acquiring hepatitis B, beliefs about the efficacy of the vaccine, and their willingness to pay for it. The need for a low-cost vaccine was demonstrated by the fact that only 35% of students would pay the wholesale price of the vaccine ($100), but 94% said they would pay $15.

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With the use of information gathered through the course of pregnancy and data collected after delivery, the changing patterns of alcohol, nicotine, and marijuana use of 288 women participating in the Ottawa Prenatal Prospective Study were investigated. The time periods considered were the year before pregnancy, each trimester of pregnancy, and 1, 6, and 12 months post partum. Alcohol use showed the most marked reduction of the three drugs during pregnancy, but a year after delivery prepregnancy drinking patterns (including binging) had been reestablished. An exception to this was a continued reduction of alcohol consumption by those categorized as heavy social drinkers prior to pregnancy. Although not as marked as the alcohol reduction, nicotine use was reduced during pregnancy and continued to remain at the reduced level 1 year post partum. Heavy marijuana use was the least reduced of the drugs during pregnancy and consumption returned to prepregnancy levels a year after the birth of the baby.

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