Navigating the Grey Zone: A Mixed-Methods Study to Evaluate a Decision Support Tool in the SOGC Late Preterm Antenatal Corticosteroids Guideline.

Abstract

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 (34⁰-36⁶ weeks') on the frequency and quality of patient counselling. Our mixed-methods study randomized six Canadian hospitals, within three 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 individuals with a late preterm livebirth 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. 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: -12.0-11.0]) or quality (satisfaction with communication, difference-in-differences 0 points [-1.30-1.30]; confidence in decision, -0.5 points [-2.20-1.20]). Obstetricians (N = 28) described three themes influencing the DST's impact: (1) limitations accessing the DST; (2) improving knowledge with variable practice change; and (3) uncertain relevance of benefits and harms. Integrating a DST into the SOGC 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.