Tailored Contraceptive Decision Support for Pregnant Women with Opioid Use Disorder

为患有阿片类药物使用障碍的孕妇提供量身定制的避孕决策支持

• 批准号: 10371497
• 负责人: Elizabeth Winston Patton
• 金额: $ 18.94万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10371497
• 关键词: Academy; Active Learning; Address; Affect; Age; Attention; Belief; Beneficence; Birth; Caring; Centers for Disease Control and Prevention (U.S.); Child; Child Welfare; Climate; Clinic; Clinical; Coercion; Complex; Consensus; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Criminal Justice; Data; Decision Aid; Decision Making; Development; Diagnosis; Discipline; Discipline of obstetrics; Education; Effectiveness; Ethics; Face; Feedback; Fertility; General Population; Goals; Health; Healthcare; Home; Illicit Drugs; Individual; Infertility; Informal Social Control; Intervention; Interview; Job loss; Justice; K-Series Research Career Programs; Knowledge; Light; Mastectomy; Medical center; Medicine; Menstruation; Mentorship; Methods; Modality; Modeling; National Institute of Drug Abuse; Nonmaleficence; Outcome; Patient Preferences; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Physicians; Population; Pregnancy; Pregnancy Rate; Pregnant Women; Prenatal care; Process; Process Assessment; Provider; Public Health; Questionnaires; Records; Recovery; Recovery Support; Reproductive Health; Research; Research Personnel; Resources; Rest; Sampling; Scholarship; Science; Sepsis; Services; Stress; Substance Use Disorder; Support System; Surveys; System; Training; United States; Woman; Work; addiction; aged; base; breast lumpectomy; clinical care; clinical practice; cognitive interview; design; evidence base; experience; high risk population; housing instability; implicit bias; improved; malignant breast neoplasm; opioid use disorder; patient oriented; peer; preference; pregnant; prenatal; reproductive; shared decision making; side effect; skills; social stigma; support tools; tool; unintended pregnancy

PROJECT SUMMARY/ABSTRACT Opioid use disorder (OUD) impacts a growing number of reproductive age women in the United States. Women with OUD have higher rates of undesired pregnancies and births than peers without OUD. For pregnant women, contraceptive decision-making is an established part of prenatal care. For pregnant women with OUD, contraceptive decision-making is uniquely complex, due to a confluence of multiple factors including stigma and clinician implicit bias and patient experiences with OUD that impact perceptions of fertility and side effects. Shared decision-making is an established approach to mitigate bias and support values concordant decision-making for contraceptive choice in the general population, but no tailored contraceptive decision support tools exist to meet the needs of pregnant women with OUD. Strategies to support pregnant with OUD and their clinical providers in making values-concordant contraceptive choices are urgently needed. In order to effectively meet both individual needs and public health aims, and advance the goal of high quality contraceptive decision-making for pregnant women with OUD, three aims are planned: 1) Qualitative interviews exploring patient and clinician experiences with stigma, coercion and ethical contraceptive counseling, as well as feedback on sample existing contraceptive decision aids (CDC, Bedsider.org, Contraceptive Access Project); 2) Iterative development of a tailored contraceptive decision aid for pregnant women with OUD using an expert panel and modified Delphi process in conjunction with patient cognitive interviews and feasibility surveys; 3) Pilot the modified contraceptive decision aid for women with OUD and their providers in a patient-centered medical obstetric home for women with OUD, and assess patient-centered outcomes including perceptions of autonomy support, shared decision-making and contraceptive knowledge. My goal is to be a leader in the design, delivery and implementation of high quality reproductive health decision-making and services for women with OUD. In pursuit of this goal, I have assembled a mentorship team of senior researchers in relevant disciplines with strong track records of mentorship, collaborative scholarship and clinical expertise. I have designed a complementary didactic and experiential learning plan to provide me with needed skills and expertise in applied ethics, decision science, qualitative, survey and mixed methods, patient centered decision support design and the intersection of addiction medicine and reproductive health. The proposed career development award includes the necessary mentorship, training and resources to become an independent investigator.

项目总结/摘要 阿片类药物使用障碍（OUD）影响着美国越来越多的育龄妇女。 患有OUD的女性比没有OUD的同龄人有更高的意外怀孕和分娩率。为 对于孕妇来说，避孕决策是产前护理的一个既定部分。孕妇 在OUD中，避孕决策是非常复杂的，这是由于多种因素的共同作用，包括 耻辱感、临床医生隐性偏见和OUD患者经历影响了对生育能力和副作用的看法 方面的影响.共同决策是一个既定的方法，以减轻偏见和支持价值观一致 在一般人群中作出避孕选择的决定，但没有针对性的避孕决定 现有的支助工具可满足患有OUD的孕妇的需要。支持OUD孕妇的策略 和他们的临床提供者在价值观一致的避孕选择是迫切需要的。 为了有效地满足个人需求和公共卫生目标，并推进高质量的目标， OUD孕妇的避孕决策，计划有三个目标：1）定性 访谈探索患者和临床医生的经验与耻辱，胁迫和道德避孕 咨询以及对现有避孕决策辅助工具样本的反馈（CDC，Bedsider.org， （2）反复制定针对孕妇的避孕决定辅助工具， 使用专家小组和改良的德尔菲法结合患者认知 访谈和可行性调查; 3）对患有OUD的妇女试行经修改的避孕决定援助， 他们的供应商在以病人为中心的医疗产科家庭的妇女与OUD，并评估以病人为中心 成果包括对自主支持、共同决策和避孕知识的看法。 我的目标是成为设计、提供和实施高质量生殖健康的领导者 决策和服务的妇女与开放式发展。为了实现这一目标，我组建了一个 相关学科的高级研究人员团队，具有良好的指导记录， 奖学金和临床专业知识。我设计了一个互补的教学和体验式学习计划， 为我提供所需的技能和专业知识，在应用伦理学，决策科学，定性，调查和混合 方法，以患者为中心的决策支持设计和成瘾医学和生殖医学的交叉 健康拟议的职业发展奖包括必要的指导、培训和资源， 成为独立调查员。