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Semra Ozdemir,1â 3 Teresa Chen,4 Chin Wen Tan,4,5 Wei Han Melvin Wong,1,2 Hon Sen Tan,4,5 Eric Andrew Finkelstein,1â 3,6 Ban Leong Sng4,5 1Health Services and Systems Research, Duke-NUS Medical School, Singapore; 2Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; 3Saw Swee Hock School of Public Health, National University of Singapore, Singapore; 4Duke-NUS Medical School, Singapore; 5Department of Womenâs Anesthesia, KK Womenâs and Childrenâs Hospital, Singapore; 6Duke University Global Health Institute, Duke University, Durham, NC, USACorrespondence: Semra Ozdemir, Duke-NUS Medical School, 8 College Road, 169857, Singapore, Tel +65 6601 3575, Email semra.ozdemir@duke-nus.edu.sgObjective: The objective was to investigate the extent to which treatment benefits, risks and costs affected parturientsâ preferences for labor analgesia.Methods: We recruited 248 healthy parturients prior to labor at an antenatal ward and administered a discrete choice experiment survey. Parturients were asked to choose among four hypothetical forms of labor analgesia: epidural analgesia, pethidine, Entonox and no analgesia, which were defined by: pain score, duration of second stage of labor, risks of instrumental delivery, back pain and permanent nerve injury, and out-of-pocket cost. We used mixed logit model to calculate the relative importance of each attribute (out of 100).Results: Parturients preferred receiving labor analgesia over not receiving analgesia and those who had positive past experience with epidural preferred epidural over other modalities. Out-of-pocket cost (28%), duration of second stage of labor (26%) and pain score following treatment (18%) were the most important attributes.Conclusion: Out-of-pocket cost was a major concern. Parturients prioritized having lower pain and shorter labor experience over risks associated with epidural analgesia. Parturients should be presented with realistic range of risks of side-effects so that they can decide how to balance risks against benefits and costs associated with child labor.Keywords: analgesia, epidural analgesia, labor analgesia, patient preferences |
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