Tailored Contraceptive Decision Support for Pregnant Women with Opioid Use Disorder

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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.