DOI: 10.3310/nihropenres.14466.1 ISSN: 2633-4402

Are Maternal Decision Aids sustained in the centre where they had been found to be effective?

Saba Tariq, Pamela Nayyar, Fran Carroll, Richard Lilford
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Background Decision aids (DAs) improve informed choice, reduce decisional conflict, and support shared decision-making. Although their effectiveness has been demonstrated repeatedly in randomised trials, little is known about whether these tools survive beyond the research programmes that created them. We therefore examined the post-study availability and sustainability of maternity decision aids identified in a systematic review. Methods We undertook a follow-up evaluation of patient-directed maternal decision aids identified from a published systematic review. For each tool, we assessed whether it remained retrievable in its original or equivalent form and whether it continued to be used in routine clinical practice. Information was obtained from published sources, supplementary materials, direct correspondence with study authors, and, where necessary, the clinical services in which the tools had originally been implemented. Reported reasons for discontinuation were interpreted using the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework. Results Five patient-directed decision aids met the inclusion criteria. Author correspondence was obtained for all five. At the time of assessment, one decision aid was reported to remain in routine clinical use, while four were reported not to be in routine use. Respondent-reported explanations included funding and licensing limitations, lack of organisational ownership or stewardship, and difficulty maintaining or updating tools and prediction models. These reasons were deductively mapped to NASSS domains. Conclusions This follow-up evaluation suggests that maintaining maternity decision aids after their original evaluation can be challenging. Investigator reports identified recurrent vulnerabilities involving funding, ownership, governance, licensing, and updating. Because current use and reasons for discontinuation were based primarily on investigator correspondence rather than systematic verification with implementing organisations, these findings should be interpreted as descriptive and hypothesis-generating.

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