American Heritage Dictionary (my personal favorite) defines treatment in a medical context as
a. The use of an agent, procedure, or regimen, such as a drug, surgery, or exercise, in an attempt to cure or mitigate a disease, condition, or injury.b. The agent, procedure, or regimen so used.
a. A drug or course of medical treatment used to restore health: discovered a new cure for ulcers.b. Restoration of health; recovery from disease: the likelihood of cure.c. Something that corrects or relieves a harmful or disturbing situation:
a. To make less severe or intense; moderate or alleviate.
The majority of participants overestimated intervention benefit and underestimated harm. Clinicians should discuss accurate and balanced information about intervention benefits and harms with patients, providing the opportunity to develop realistic expectations and make informed decisions.
[A] physician must first understand the risk herself (or himself) and must then communicate it effectively. It is not clear that physicians do either of these things well.
Women in both groups [TOLAC or ERCS] were insufficiently informed about the risks and benefits of TOLAC and ERCS, particularly women in the ERCS group. Specifically, our patients were not familiar with
- the chances of a successful TOLAC,
- the effect of indication for previous cesarean section on success,
- the risk of uterine rupture,
- the increased length of recovery with ERCS versus TOLAC
- the increased risk of maternal death, neonatal respiratory compromise, and neonatal intensive care unit admission with ERCS.
In addition, if our patient felt her provider had a preference, she was more likely to choose that mode of delivery, whereas when patients felt their providers were indifferent or if they were unaware of their providers’ preferences, 50% chose one mode and 50% chose the other.
- Jessica: I was told I need not waste my time trying to attempt a vaginal birth because it would be another long birth that would ultimately end in another section.
- Jenerra: “I was always told by my doctors that because I had my first c-section that I would have to keep having them, even though my first c-section was the result of an induction gone wrong.”
- Kiara: I do believe that [my primary cesarean] was the best outcome for everyone, but I knew that I didn’t want that
experience again. When I discussed this with my OB, she said ‘Oh, we don’t do VBACs in this practice. When you get pregnant again, we’ll just schedule you like a hair appointment. Easy!’
- Jamie: [My OB said], “You don’t want to VBAC. You don’t need to tear up your little bottom.”
This study, and others, indicate that patients would opt for less care if they had more information about what they may gain or risk with treatment. Shared decision-making in which there is an open patient-physician dialogue about benefits and harms, often augmented with use of treatment decision aids, like videos, would help patients get that information.