Patients were more consistent in randomized trial at prioritizing childbirth preferences using graphic-numeric than verbal formats

Karen B. Eden, James G. Dolan, Nancy A. Perrin, Dundar Kocaoglu, Nicholas Anderson, James Case, Jeanne Marie Guise

Research output: Contribution to journalArticle

15 Scopus citations


Objective: We developed an evidence-based decision aid to help women with a prior cesarean to prioritize their childbirth preferences related to a future birth. Because there was uncertainty about which scale format would assist the patients in being most consistent in prioritizing preferences in a multiattribute decision model, we compared a graphic-numeric scale with a text-anchored scale. Study Design and Setting: Ninety-six postnatal women with a prior cesarean were randomized to use 1 of 2 preference scale formats in a computerized childbirth decision aid. We measured the level of inconsistency (intransitivity) when patients prioritized their childbirth preferences and clarity of values before and after using the decision aid. Results: When the trade-offs involved risk, women were more consistent when using graphic-numeric than text-anchored formats (P = 0.015). They prioritized safety to their baby as 4 times more important than any other decision factor including safety to self. Both groups reduced unclear childbirth values over time (P < 0.001). Women who over-used the extreme ends of the scale when evaluating risk were more likely to be inconsistent (P < 0.001). Conclusion: Patients were more consistent in making trade-offs involving risk using graphic-numeric formats than text-anchored formats to measure patient preferences.

Original languageEnglish (US)
JournalJournal of Clinical Epidemiology
Issue number4
StatePublished - Apr 2009
Externally publishedYes



  • Analytic hierarchy process
  • Decision aid
  • Decision support techniques
  • Patient preferences
  • Pregnancy
  • Vaginal birth after cesarean

ASJC Scopus subject areas

  • Epidemiology

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