Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers

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Abstract
With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care. Women were shocked at some of the contents but thought that it was appropriate to include both advantages and disadvantages of routine scanning in the leaflet. This case study highlights the resistance of some health professionals to evidence based health care; underlying conflicts with the principle of professional autonomy; concern that informed choice may create anxiety; and professional and organisational barriers to allowing informed choice. Two important themes in current health policy are the value of informed choice for users of health services and the move towards evidence based health care. Greater participation of users in health care is often seen as desirable and may be beneficial.1 2 3 4 5 Evidence based health care is a method of basing clinical decisions on the best available scientific evidence.6 7 Parallel leaflets to promote the informed choice of pregnant women on the basis of published evidence have been developed for pregnant women and health professionals by the Midwives' Information and Resource Service and the NHS Centre for Reviews and Dissemination as part of the “Informed Choice” initiative. The women's leaflets are designed to be given to them by health professionals, and they encourage women to participate in decisions about their maternity care. They …