Communication and shared decision-making after stillbirth: Results of the ShaDeS study

Background: Shared decision-making (SDM) is included in guidelines for bereavement care after a stillbirth, as it can improve women’s long-term health and wellbeing. SDM within the stillbirth context is still not common, and Italy does not yet have standardised guidelines. Aim: The ShaDeS (Shared Decision-Making in Stillbirth) study aims to investigate how Italian women with a stillbirth perceive their own centrality in decision-making processes around bereavement care and how this might impact satisfaction of care. Methods: The ShaDeS study is a cross-sectional study based on a web survey consisted of four sections: socio- demographic information and medical history, communication of bad news and bereavement care, decisions about childbirth (SDM-Q-9, SHARED, and DCS), and decisions and communication about autopsy (CPS). Findings: 187 women answered the survey. For the 41.1% of women that did not have an emergency childbirth, the SDM-Q-9 median score was 66.6 (0–100 range), and the SHARED median score was 3.5 (1–5 range). 29.4% of participants reached the proposed cutoff of 37.5 in the DCS (0–100 range) suggesting a difficulty in reaching decisions. Satisfaction scores were lower for those with such difficulties (p < 0.0001). Of the 64.5% of women that discussed autopsy, 28.3% were involved in an SDM approach, despite this being associated with higher levels of satisfaction of care (p < 0.05). Conclusion: An SDM approach is only moderately widespread amongst our participants, despite it being signif- icantly related to higher levels of satisfaction. Further studies should investigate the tools that both patients and healthcare professionals need for an SDM approach.