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.

项目摘要/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。 患有胎儿发育迟缓的女性比没有胎儿发育迟缓的同龄人有更高的意外妊娠率和产出率。为 对于孕妇来说，避孕决策是产前护理的既定组成部分。对怀孕妇女来说 在OUD中，避孕决策是独特复杂的，这是多种因素的汇合，包括 耻辱和临床医生的内隐偏见和OUD患者的经历影响对生育和侧面的看法 效果。共享决策是缓解偏见和支持一致价值观的既定方法 一般人群的避孕选择决策，但没有量身定做的避孕决策 已有支持工具来满足患有胎儿窘迫的孕妇的需求。支持妊娠高血压综合征的策略 迫切需要他们的临床提供者做出与价值观一致的避孕选择。 为有效满足个人需求和公共卫生目标，推进高质量目标 孕妇的避孕决策有三个目标：1)定性 采访探讨患者和临床医生对耻辱、强迫和道德避孕的体验 咨询，以及对现有避孕决策辅助工具样本的反馈(CDC，Bedsider.org， 避孕措施获取项目)；2)反复开发为孕妇量身定做的避孕决策辅助工具 使用专家小组和改进的Delphi过程结合患者认知的OUD女性 访谈和可行性调查；3)试行为患有OUD和OUD的妇女提供修订的避孕决策援助 他们的提供者在以患者为中心的产科之家为患有OUD的妇女提供医疗服务，并以患者为中心进行评估 结果包括对自主支持、共享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 为患有妇产科疾病的妇女提供决策和服务。为了追求这个目标，我召集了一个导师 相关学科的资深研究人员团队，具有良好的指导记录，协作 学术和临床专业知识。我设计了一个互补的授课和体验式学习计划来 为我提供应用伦理学、决策科学、定性、调查和混合方面所需的技能和专业知识 方法：以患者为中心的决策支持设计与成瘾医学与生殖医学的交叉 健康。拟议的职业发展奖包括必要的指导、培训和资源，以 成为一名独立调查员。