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Preference Elicitation and Assessment of Technologies (PEAT) Programme Project No: B1.6 Projects completed Project Title: A cluster randomised trial to investigate the use of decision aid for the diagnosis of active labour in term pregnancy. Grant Applicants / Cheyne, H., Niven, C. (University of Stirling) Hundley, V. (University of Principal Investigators Stirling & Aberdeen) Dowding, D. (University of York) Greer, I. (place of work): (University of Glasgow) Bland, M. (University of York) Aucott, L. (Department of Population Health, University of Aberdeen) McNamee, P. (HERU) HERU Investigators: McNamee, P and Scotland, G. HERU Research Assessment of Technologies Theme: Source of Funding and CSO - £201,538 Total Awarded: Amount of HERU £12,031 Funding: Objectives: To assess the effectiveness and cost-effectiveness of a decision aid for the diagnosis of active labour in term pregnancy. Outline: Admission of women who are not in labour accounts for 10% to 30% of maternity admissions. This is an unnecessary burden on resources. Women admitted in latent labour have the appearance of a longer labour and are more likely to receive a cascade of intervention starting with administration of oxytocin and including caesarean section. A previous study developed and tested a decision aid for diagnosis of active labour and assessed the feasibility of conducting a cluster randomised trial. This study went on to conduct the cluster randomised controlled trial, recruiting twelve maternity units with an average cluster size of 200 women, with units randomly allocated to receive either the decision aid or standard care. Outcomes included use of oxytocin, interventions and analgesia in labour, mode of delivery. NHS costs and costs to women were also assessed. Outcome and This was the largest ever randomised controlled trial of an initiative aimed Translation: at reducing early admissions to the labour ward. However, the proposed algorithm was not effective in changing use of resources or improving outcomes. As a result there are no plans to implement the algorithm. Future initiatives to reduce early admission to the labour ward need to focus on the perspectives of women as well as those of clinicians. Start Date: April 2005 2 years Duration of Project: Project Phase: Publications: Cheyne, H., Terry, R., Niven, C., Dowding, D., Hundley, V. and McNamee, P. Should I come in now? A study of women's early labour experiences. British Midwifery Journal. 2007; 15(10): 604-625. Cheyne, H., Hundley, V., Dowding, D., Bland, J.M., McNamee, P., Greer, I.A., Styles, M., Barnett, C.A., Scotland, G.S. and Niven, C.A. Effects of algorithm for diagnosis of active labour: a cluster randomised trial. British Medical Journal 2008; 337(7683): a2396 Cheyne, H., Hundley, V., Dowding, D., Niven, C., Greer, I., Bland, J.M., Aucott, L. and McNamee, P. A cluster randomised trial to investigate the use of a decision aid for the diagnosis of active labour in term pregnancy (The Early Labour Study in Scotland). Chief Scientist Office Final Report. July 2007. Other Dissemination Cheyne, H., Hundley, V., Dowding, D., Aucott, L., McNamee, P., Styles, Activities: M., Barnett. C.A., Greer, I., Bland, M. and Niven, K. The Early Labour Study in Scotland: Measuring the Benefits of an algorithm for diagnosis of active labour using Discrete Choice Experiments. Triennial International Confederation of Midwives Congress. Glasgow. 2008. Cheyne, H. and McNamee, P. The early labour study in Scotland – TELSIS. Dugald Baird Centre. University of Aberdeen, 2008. Scotland, G.S., and McNamee, P. Measuring the Benefits of an algorithm for diagnosis of active Labour: Results from a Discrete Choice Experiment (DCE). Accepted as part of The Early Labour Study in Scotland (TELSiS) symposium. Congress of the International Confederation of Midwives. Glasgow, June 2008. Scotland, G.S., McNamee, P. and Ryan, M. Should we be concerned about learning effects in discrete choice experiments? European Conference on Health Economics. University of Rome July 2008.
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