Improving contraceptive decision support for individuals with chronic conditions

项目摘要 患有慢性病的妇女更有可能经历意外怀孕， 妊娠并发症多于无慢性病的同龄人。因为避孕药不使用（不 使用任何避孕方法）造成意外怀孕的风险最大， 在慢性病患者中，迫切需要支持这一群体的避孕目标。 避孕决策是避孕药具使用的重要前提，也是一个高度个人化的过程。一 一个重要的临床护理差距是缺乏资源，以解决独特的避孕决定的需要， 对慢性病患者，如了解哪些方法可以改善或恶化他们的 症状（例如，贫血）或疾病自我管理（例如，重量）。患者也应该知道他们的慢性 条件对特定方法构成健康禁忌，如果是，可以使用哪些其他方法 平安然而，临床医生，包括初级保健提供者，并不经常引起患者的偏好， 应用循证避孕指南为慢性病患者提供咨询。解决这些 我们设计了一个基于网络的工具，我的健康我的选择（MHMC），教育慢性病患者， 了解他们的避孕选择，并促进临床医生遵守避孕指南， 疾病控制和预防中心（CDC）。MHMC是创新的，因为它是第一个理论- 知情的、经过用户测试的避孕决策支持工具，针对慢性病患者， 他们的临床医生。我们的长期目标是通过避孕措施改善生殖健康， 一般护理设置。基于我们有希望的试点数据，研究的目的是评估 一项采用混合方法比较MHMC（干预）的双臂、平行分组随机试验中的MHMC 在14个提供避孕服务的初级保健诊所接受常规避孕护理（对照）。我们假设 MHMC的使用将改善患者报告的避孕决策质量和避孕质量 从他们的临床医生咨询，这将导致增加避孕药具的使用和减少避孕 没用本研究的目的是：目的1（主要）：评估MHMC对避孕不使用的影响。目的 2（次要）：评估MHMC对遵守CDC避孕指南的影响，使用 混合方法。目的3：（探索性）：定量探讨决策质量和避孕 心理咨询作为MHMC对主要和次要措施影响的中介。预期 结果是关于一种新的避孕决策工具对患有 慢性病该项目将为可扩展的、以人为本的避孕药具的开发提供信息。 在现实世界的临床环境中对医学上有风险的患者进行干预。

PROJECT ABSTRACT Women with pre-existing chronic conditions are more likely to experience unplanned pregnancy and pregnancy complications than their peers without chronic conditions. Because contraceptive nonuse (not using any contraceptive method) poses the greatest risk of unplanned pregnancy and is more prevalent among those with chronic conditions, there is an urgent need to support the contraceptive goals of this group. Contraceptive decision-making is a critical antecedent to contraceptive use, and a highly personal process. A significant clinical care gap is the lack of resources that address the unique contraceptive decision needs of patients with chronic conditions, such as understanding which methods may improve or worsen their symptoms (e.g., anemia) or disease self-management (e.g., weight). Patients should also know if their chronic conditions pose a health contraindication to a specific method, and if so, which other methods can be used safely. However, clinicians, including primary care providers, do not routinely elicit patient preferences or apply evidence-based contraceptive guidelines to counsel patients with chronic conditions. To address these gaps, we designed a web-based tool, My Health My Choice (MHMC), to educate patients with chronic conditions about their contraceptive options and promote clinician adherence to contraceptive guidelines from the Centers for Disease Control and Prevention (CDC). MHMC is innovative because it is the first theory- informed, user-tested contraceptive decision support tool that targets both patients with chronic conditions and their clinicians. Our long-term goal is to improve reproductive health through contraceptive interventions in general care settings. Building upon our promising pilot data, the study objective is to evaluate the efficacy of MHMC in a two-arm, parallel cluster-randomized trial using mixed methods to compare MHMC (intervention) to usual contraceptive care (control) in 14 primary care clinics that provide contraception. We hypothesize that MHMC use will improve patient-reported quality of contraceptive decision-making and quality of contraceptive counseling from their clinicians, which will lead to increased contraceptive use and decreased contraceptive nonuse. The study aims are: Aim 1(Primary): To evaluate the impact of MHMC on contraceptive nonuse. Aim 2 (Secondary): To assess the impact of MHMC on adherence to the CDC Contraceptive Guidelines using mixed methods. Aim 3: (Exploratory): To quantitatively explore decisional quality and contraceptive counseling as mediators of the effects of MHMC on primary and secondary measures. The expected outcomes are new findings regarding the efficacy of a novel contraceptive decision tool for individuals with chronic conditions. This project will inform the development of scalable, person-centered contraceptive interventions for medically at-risk patients in real-world clinical settings.