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Aref HAT, Turk T, Dhanani R, Xiao A, Olson J, Paul P, Dennett L, Yacyshyn E, Sadowski CA. Development and evaluation of shared decision-making tools in rheumatology: A scoping review. Semin Arthritis Rheum 2024; 66:152432. [PMID: 38554593 DOI: 10.1016/j.semarthrit.2024.152432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Shared decision-making (SDM) tools are facilitators of decision-making through a collaborative process between patients/caregivers and clinicians. These tools help clinicians understand patient's perspectives and help patients in making informed decisions based on their preferences. Despite their usefulness for both patients and clinicians, SDM tools are not widely implemented in everyday practice. One barrier is the lack of clarity on the development and evaluation processes of these tools. Such processes have not been previously described in the field of rheumatology. OBJECTIVE To describe the development and evaluation processes of shared decision-making (SDM) tools used in rheumatology. METHODS Bibliographic databases (e.g., EMBASE and CINAHL) were searched for relevant articles. Guidelines for the PRISMA extension for scoping reviews were followed. Studies included were: addressing SDM among adults in rheumatology, focusing on development and/or evaluation of SDM tool, full texts, empirical research, and in the English language. RESULTS Of the 2030 records screened, forty-six reports addressing 36 SDM tools were included. Development basis and evaluation measures varied across the studies. The most commonly reported development basis was the International Patient Decision Aids Standards (IPDAS) criteria (19/36, 53 %). Other developmental foundations reported were: The Ottawa Decision Support Framework (ODSF) (6/36, 16 %), Informed Medical Decision Foundation elements (3/36, 8 %), edutainment principles (2/36, 5.5 %), and others (e.g. DISCERN and MARKOV Model) (9/31,29 %). The most commonly used evaluation measures were the Decisional Conflict Scale (18/46, 39 %), acceptability and knowledge (7/46, 15 %), and the preparation for decision-making scale (5/46,11 %). CONCLUSION For better quality and wider implementation of such tools, there is a need for detailed, transparent, systematic, and consistent reporting of development methods and evaluation measures. Using established checklists for reporting development and evaluation is encouraged.
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Affiliation(s)
- Heba A T Aref
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Tarek Turk
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Ruhee Dhanani
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Andrew Xiao
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Joanne Olson
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Pauline Paul
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Alberta, Canada
| | - Elaine Yacyshyn
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada.
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Naye F, Toupin-April K, de Wit M, LeBlanc A, Dubois O, Boonen A, Barton JL, Fraenkel L, Li LC, Stacey D, March L, Barber CEH, Hazlewood GS, Guillemin F, Bartlett SJ, Berthelsen DB, Mather K, Arnaud L, Akpabio A, Adebajo A, Schultz G, Sloan VS, Gill TK, Sharma S, Scholte-Voshaar M, Caso F, Nikiphorou E, Nasef SI, Campbell W, Meara A, Christensen R, Suarez-Almazor ME, Jull JE, Alten R, Morgan EM, El-Miedany Y, Singh JA, Burt J, Jayatilleke A, Hmamouchi I, Blanco FJ, Fernandez AP, Mackie S, Jones A, Strand V, Monti S, Stones SR, Lee RR, Nielsen SM, Evans V, Srinivasalu H, Gérard T, Demers JL, Bouchard R, Stefan T, Dugas M, Bergeron F, Beaton D, Maxwell LJ, Tugwell P, Décary S. OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments. Semin Arthritis Rheum 2024; 65:152344. [PMID: 38232625 DOI: 10.1016/j.semarthrit.2023.152344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Shared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2. METHODS We conducted a scoping review (PRISMA-ScR) to identify candidate instruments for the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table. RESULTS We found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table. CONCLUSION We identified 220 candidate instruments used in the SDM literature amongst people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada
| | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada; VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Olivia Dubois
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, Arthritis Research Canada, University of British Columbia, Vancouver, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lyn March
- Department of Medicine, The University of Sydney, Sydney, Australia; Institute of Bone and Joint Research, Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University, Canada; Research Institute - McGill University Health Centre, Canada; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, Odense & Department of Rehabilitation, Municipality of Guldborgsund, Odense University Hospital, University of Southern Denmark, Nykoebing, Denmark
| | | | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, France
| | | | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, UK
| | | | - Victor S Sloan
- Sheng Consulting LLC, Flemington, NJ, USA; The Peace Corps, Washington, DC, USA
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Marieke Scholte-Voshaar
- Patient Research Partner, Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Willemina Campbell
- Patient research partner, Toronto Western Hospital, University Health Network, Canada
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Denmark
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington, Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Simon R Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Demark, Copenhagen, Denmark
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital, Washington DC, USA; GW School of Medicine, Washington DC, USA
| | - Thomas Gérard
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | | | - Roxanne Bouchard
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Théo Stefan
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Michèle Dugas
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | | | | | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Perez-Barbosa L, Skinner-Taylor CM, Lujano-Negrete AY, Barriga-Maldonado ES, Peláez-Ballestas I, Espinosa-Banuelos LG, Cardenas-de la Garza JA, Riega-Torres J, Galarza-Delgado DA. Construction and validation of a reproductive behavior questionnaire for female patients with rheumatic diseases. Clin Rheumatol 2023; 42:2453-2460. [PMID: 37335407 DOI: 10.1007/s10067-023-06652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION/OBJECTIVES Active autoimmune rheumatic diseases (ARDs) before conception increase the risk of flares and adverse pregnancy outcomes. We aimed to construct and validate a reproductive behavior questionnaire in Spanish for patients with ARDs to assess their knowledge and their reproductive behavior. METHOD We constructed and validated a reproductive behavior questionnaire in two phases: (1) a literature review followed by interviews of reproductive-age female patients, and (2) a cross-sectional study to complete validation. Convenience sampling was carried out with 165 female patients: 65 participated in the cross-cultural adaptation phase and 100 in the validation phase. The internal consistency was evaluated by estimating Cronbach's alpha and tetrachoric correlation coefficients. Values ≥ 0.40 were considered acceptable (p < 0.05). RESULTS The initial instrument included 38 questions. Thematic analysis identified 8 important dimensions or topics, which were combined to create the Rheuma Reproductive Behavior interview questionnaire. A final total of 41 items across 10 dimensions were obtained. The test-retest analysis showed perfect correlations in 34 of the 41 items, moderate in 6 items, and negative in one of the items. The mean age of the patients was 35.65 years (SD 9.02), and the mean time to answer the survey was 13.66 min (SD 7.1). CONCLUSIONS The Rheuma Reproductive Behavior questionnaire showed good reliability and consistency capturing patients' reproductive health knowledge and reproductive behavior. Key Points • We designed and validated a questionnaire to assess reproductive health knowledge and reproductive behavior among female patients with ARDs. • The questionnaire was comprehensible for participants, and showed good reliability and consistency capturing reproductive knowledge and behavior. • This tool may aid in the design of strategies to improve reproductive decision-making for female patients with ARDs.
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Affiliation(s)
- Lorena Perez-Barbosa
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Cassandra Michele Skinner-Taylor
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.
| | - Abraham Yair Lujano-Negrete
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Eugenio Salvador Barriga-Maldonado
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ingris Peláez-Ballestas
- Rheumatology Department, Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Luis Gerardo Espinosa-Banuelos
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Janett Riega-Torres
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Dionicio Angel Galarza-Delgado
- Rheumatology Department, Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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Kalpakjian CZ, Haapala HJ, Ernst SD, Orians BR, Barber ML, Mulenga L, Bolde S, Kreschmer JM, Parten R, Carlson S, Rosenblum S, Jay GM. Development and pilot test of a pregnancy decision making tool for women with physical disabilities. Health Serv Res 2023; 58:223-233. [PMID: 36401816 PMCID: PMC9836953 DOI: 10.1111/1475-6773.14103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Heidi J. Haapala
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan D. Ernst
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Lukonde Mulenga
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Shannen Bolde
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Rebecca Parten
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Carlson
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sara Rosenblum
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Gina M. Jay
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Morrison T, Foster E, Dougherty J, Barton J. Shared Decision Making in Rheumatology: A Scoping Review. Semin Arthritis Rheum 2022; 56:152041. [DOI: 10.1016/j.semarthrit.2022.152041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
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Mothers' experiences of wellbeing and coping while living with rheumatoid arthritis: a qualitative study. BMC Womens Health 2022; 22:185. [PMID: 35590408 PMCID: PMC9118808 DOI: 10.1186/s12905-022-01767-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rheumatoid arthritis (RA) can result in difficulties for mothers when undertaking daily care activities and increased psychological distress. However, few studies have examined how women with RA subjectively experience coping and wellbeing as part of their motherhood.
Methods Twenty mothers with a diagnosis of RA and a dependent child (18 years or younger) who were living in Australia took part in a semi-structured interview between June and November 2017. Purposive sampling was undertaken to include participants across degree of current RA severity, number and age of children, and having received a diagnosis before or after a first child to take account of variability across these experiences. A qualitative thematic analysis was conducted on the interview transcripts. Results The following themes were identified: ‘Burden and complexity in the mothering role’, ‘Losing control: Women’s experiences of distress’, and ‘Adjusting and letting go: Women’s experiences of wellbeing’. Experiences of distress, including feelings of failure, were associated with accounts of a loss of control over mothering practices among women, regardless of child age. In contrast, accounts of adjusting mothering practices and relinquishing control were associated with reports of enhanced wellbeing. In addition, some mothers reported greater ease due to increased independence of older children. The absence of social support exacerbated burden and distress in the women’s accounts, while the availability of support alleviated burden and was associated with reports of wellbeing. Conclusion Health professionals and services can provide support to mothers with RA by addressing feelings of failure, acknowledging strategies of adjustment and letting go, and encouraging access to social support.
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Hammarberg K, Stocker R, Romero L, Fisher J. Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis. BMC Pregnancy Childbirth 2022; 22:236. [PMID: 35317730 PMCID: PMC8941766 DOI: 10.1186/s12884-022-04498-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/11/2022] [Indexed: 12/18/2022] Open
Abstract
Background Preparing for pregnancy and being in the best possible health before conception improves reproductive outcomes. For women living with a chronic non-communicable disease (NCD), pregnancy planning is essential to allow optimal disease control in preparation for pregnancy. Aim The aim was to review the literature relating to the pregnancy planning health information and service needs of women with NCDs. Method The MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), CINAHL and Scopus databases were searched. Studies were included if they were published in peer-reviewed English language journals between January 2010 and June 2020 and reported on the pregnancy planning health information and service needs of women with rheumatic diseases, asthma, cystic fibrosis, depression and/or anxiety, type 1 diabetes mellitus, epilepsy, or multiple sclerosis. Risk of bias was assessed using QualSyst. The characteristics of the studies were tabulated and summarised. Key findings of the included studies were analysed thematically using an inductive approach, where the study findings determined the themes. Findings are reported in a narrative synthesis. Results The database searches yielded 8291 results, of which 4304 remained after duplicates were removed. After abstract screening 104 full-text papers were reviewed. Of these 15 met inclusion criteria and were included in analysis. The narrative synthesis of the included studies revealed six themes: ‘Women with chronic conditions have unmet preconception health information needs’, ‘Women with chronic conditions want personalised preconception health information’, ‘Preferred sources of preconception health information’, ‘Learning from the experiences of other women’, ‘Improving preconception health discussions with health care professionals’, and ‘Women want holistic care’. These themes were consistent across all studies, highlighting the similarity of experiences and needs of women with different chronic conditions. Conclusion To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive. PROSPERO registration number CRD42020176308. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04498-1.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Ruby Stocker
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Whybrow R, Webster LM, Seed PT, Sandall J, Chappell LC. The effectiveness of decision aids for pregnancy related decision-making in women with pre-pregnancy morbidity; systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:81. [PMID: 35093017 PMCID: PMC8801107 DOI: 10.1186/s12884-022-04402-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/11/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Women with pre-existing morbidity arising from medical conditions or previous caesarean section are at higher risk of adverse pregnancy outcomes compared to women without such morbidity. Women often face complex pregnancy-related decision-making that may be characterized by conflicting maternal and perinatal priorities. The aim of this systematic review and meta-analysis was to assess randomised controlled trials of decision aids to evaluate whether they are effective at reducing decisional conflict scores and to evaluate what type of decision aids are most effective for women with pre-existing morbidity in pregnancy. METHODS We searched Medline (via Ovid), Embase (via Ovid), CINAHL (via EBSCO) from the earliest entries until September 2021. We selected randomised controlled trials comparing patient decision aids for women with pre-existing morbidity with usual clinical practice or a control intervention. Study characteristics and Jadad risk of bias was recorded. Meta-analysis by pre-existing morbidity type was performed using Stata 17 and the data was presented with a Forest Plot. Random effects models were used to calculate summary estimates if there was substantial clinical or statistical heterogeneity and post mean DCS scores were described in a sensitivity analysis and presented as a line graph, to improve clinical interpretation of results.. A narrative synthesis of the selected studies evaluated what type of decision aid works and for in what circumstances. RESULTS Ten randomised controlled trials, which reported data from 4028 women, were included. Patient decision aids were evaluated in women with pre-existing morbidity who were undertaking pregnancy-related decision-making. Patient decision aids reduced decisional conflict scale scores by an additional - 3.7, 95% Confidence Interval - 5.9% to - 1.6%) compared to the control group. Women with pre-existing medical conditions were more conflicted at baseline and had greater reductions in decisional conflict scale score (mean difference vs. control group: - 6.6%; 95% CI - 9.8% to - 3.3%), in contrast to those with previous caesarean section (mean difference - 2.4%; 95% CI - 4.8% to - 0.1%). There was limited evidence on the effect of decision aids on health outcomes. Decision aids reduced unwanted variation in decision-making support across maternity settings. CONCLUSION Patient decision aids are effective tools to support personalised care planning and informed decision-making in women with pre-existing morbidity. Women with pre-existing medical morbidity were more conflicted at baseline and were more likely to benefit from decision aids. Adoption of aids in this population may lead to improve adherence and health outcomes, warranting further research.
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Affiliation(s)
- Rebecca Whybrow
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK.
| | - Louise M Webster
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, Westminster Bridge Road, London, UK
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A Novel Decision Aid Improves Quality of Reproductive Decision-Making and Pregnancy Knowledge for Women with Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:4303-4314. [PMID: 35499712 PMCID: PMC9352739 DOI: 10.1007/s10620-022-07494-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women with inflammatory bowel disease (IBD) with poor IBD-specific reproductive knowledge experience more childlessness and fear of IBD medications in pregnancy. The Pregnancy in IBD Decision Aid (PIDA), developed by an international multidisciplinary team, offers personalized online decision support regarding pregnancy in IBD. AIMS Assess the impact of PIDA on quality of reproductive decision-making and pregnancy-related knowledge among preconception (PC) and pregnant patients with IBD, and evaluate acceptability to patients and clinicians. METHODS PC and pregnant patients with IBD aged 18-45 completed questionnaires pre- and post-PIDA to assess quality of decision-making (Decisional Conflict Scale (DCS); Decision Self-Efficacy Scale (DSES) and IBD-in-pregnancy knowledge (Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow)). Paired t test assessed for differences pre- and post-PIDA. Patients and clinicians completed acceptability surveys. RESULTS DCS and DSES were completed by 74 patients (42 Crohn's disease, 32 ulcerative colitis); 41 PC and 33 pregnant. DCS improved significantly post-PIDA in PC patients regarding pregnancy planning (t(40) = 4.83, p < 0.0001, Cohen's dz = 0.75) and in pregnant patients regarding medication management (t(32) = 2.37, p = 0.0242, dz = 0.41). DSES for PC patients improved significantly post-PIDA (t(40) = -3.56, p = 0.001, dz = -0.56). CCPKnow improved significantly post-PIDA in PC (t(42) = 4.93, p < 0.0001, dz = -0.75) and pregnant patients (t(32) = 5.1, p < 0.0001, dz = -0.89). PIDA was deemed optimal for length, readability, and content amount and considered highly useful by patients (n = 73) and clinicians (n = 14). CONCLUSIONS Patients using PIDA developed an improved quality of reproductive decision-making and IBD-in-pregnancy knowledge. PIDA is an accessible tool that can empower women with IBD to make values-congruent, evidence-based decisions regarding pregnancy and may reduce voluntary childlessness.
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Effectiveness of patient decision aids in women considering psychotropic medication use during pregnancy: a literature review. Arch Womens Ment Health 2021; 24:569-578. [PMID: 33751206 DOI: 10.1007/s00737-021-01118-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
Women face complicated decisions regarding psychotropic medication use during pregnancy. Patient decision aids (PDAs) could be a valuable tool to assist with decision-making. The objective of this review was to evaluate the effectiveness of PDAs in this population. A systematic search of the literature was conducted using PRISMA guidelines. Three major databases were searched to identify articles published between 2006 and June 2020. Studies were included if they evaluated use of a PDA for women considering medication for mental illness during pregnancy. A total of 4629 titles were returned from the search; however, only three studies met inclusion criteria and were selected for analysis. Two were pilot randomised controlled trials in women considering antidepressant use during pregnancy, and one was a non-randomised study in women considering medication for the treatment of opioid use disorder (OUD). The PDAs had good acceptability across all three studies. The randomised trials assessed knowledge, decisional conflict, depression, and anxiety, with non-significant trends towards reduced decisional conflict and anxiety in the PDA groups. PDAs have the potential to assist women with mental illnesses to make decisions regarding medication use during pregnancy; however, current evidence is too limited to evaluate the effectiveness of PDAs for this population.
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Rheumatology-led pregnancy clinic: patient-centred approach. Clin Rheumatol 2021; 40:3875-3882. [PMID: 33759082 DOI: 10.1007/s10067-021-05690-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/21/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Autoimmune rheumatic diseases (ARDs), which include all types of inflammatory arthritis as well as systemic Lupus, are known to have a detrimental effect on both fertility and pregnancy outcomes. Consequently, reproductive health care is considered a principle constituent of comprehensive care for all patients with rheumatic ailments seen in the standard practice. Whilst pregnancy-associated complications have been reported in lupus, rheumatoid arthritis, and Sjogren's syndrome, in some conditions such as lupus, antiphospholipid syndrome, inflammatory myopathies, and vasculitis, the pregnancy may accelerate the disease progression. Furthermore, the activity of some diseases such as lupus and antiphospholipid syndrome may be augmented by some contraceptive methods. Therapeutically, some patients are prescribed medications, such as methotrexate and mycophenolate which have potentially teratogenic effect. Therefore, to be able to help those patients, family planning should be patient-centred with decision-making tailored to the individual's disease status. For those healthcare professionals interested in reproductive health care for their patients living with autoimmune rheumatic diseases, this review summarizes the available information in the literature and offers practical suggestions of patient-centred care in a dedicated rheumatology-led pregnancy clinic. Key Points • Autoimmune disorders, particularly systemic inflammatory rheumatic diseases, affect many women, often during childbearing age. • Pregnancies in this cohort of patients with rheumatic diseases is considered to be of high risk, because of the potential for complications during periods of active disease and the possible impact of medications used on both the pregnancy outcomes as well as the baby. • There are high chances of successful and safe pregnancies particularly if pre-pregnancy planning and screening for maternal and fetal risks are undertaken, and pregnancy takes place while the disease is well controlled. Encouraging the patients, who are in their childbearing period, to initiate discussions about family planning and pregnancy, with their treating rheumatologists, would be an ideal approach to close this gap of information exchange. • Targeted patients' education is expected to improve the information quality and promote more collaborative decision-making with regard to motherhood and healthcare choices.
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Skinner-Taylor CM, Perez-Barbosa L, Corral-Trujillo ME, Perez-Onofre I, Barriga-Maldonado ES, Cardenas-de la Garza JA, Riega-Torres J, Galarza-Delgado DA. Anxiety and depression in reproductive age women with rheumatic diseases. Rheumatol Int 2020; 40:1433-1438. [PMID: 32372140 DOI: 10.1007/s00296-020-04591-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/18/2020] [Indexed: 01/05/2023]
Abstract
Women in reproductive age with rheumatic diseases (RD) are especially vulnerable for depression and anxiety which negatively impacts the pregnancy, birth, and RD. The purpose of this study is to describe the frequency of anxiety and depression symptoms employing the Hospital Anxiety and Depression Scale (HADS) in women in reproductive age. We conducted an observational, single-center, cross-sectional, and descriptive study in reproductive-age, non-pregnant women without a prior psychiatric diagnosis. Differences between disease groups, subscale results, and disease activity were analyzed with the Chi square, Mann-Whitney U test, or Kruskal-Wallis test. A total of 100 women were included. Mean age was 35.3 years (SD = 10.07). The most frequent diagnosis was rheumatoid arthritis (RA) with 48, followed by systemic lupus erythematosus (SLE) with 30. A total of 66 (66%) patients had an abnormal HADS score (probable or possible cases) in either subscale. More than 50% of RA patients had an abnormal HADS score. We found an association between RA disease activity groups and total HADS score (p = 0.003). Furthermore, we found a statically significant association between RA activity groups and HADS anxiety subscales group classification (p = 0.01). No differences between disease activity groups of SLE or other diseases and HADS classification or total score was found (p = 0.277). A high frequency of probable or possible cases of depression and anxiety were recognized in reproductive-age women with RD. A high RA disease activity was associated with a high total HADS score and an increased presence of anxiety symptoms.
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Affiliation(s)
- Cassandra Michele Skinner-Taylor
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico
| | - Lorena Perez-Barbosa
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico.
| | - Maria Eugenia Corral-Trujillo
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico
| | - Itzel Perez-Onofre
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico
| | - Eugenio Salvador Barriga-Maldonado
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico
| | - Janett Riega-Torres
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico
| | - Dionicio Angel Galarza-Delgado
- Rheumatology Service, Hospital Universitario "Dr. José Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 Norte, Colonia Mitras Centro, C.P 64460, Monterrey, Nuevo León, Mexico
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Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology. Obstet Gynecol 2020; 135:444-451. [DOI: 10.1097/aog.0000000000003664] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Birru Talabi M, Clowse MEB, Blalock SJ, Switzer G, Yu L, Chodoff A, Borrero S. Development of ReproKnow, a reproductive knowledge assessment for women with rheumatic diseases. BMC Rheumatol 2019; 3:40. [PMID: 31660532 PMCID: PMC6805554 DOI: 10.1186/s41927-019-0091-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to develop an assessment tool, ReproKnow, to evaluate the reproductive health knowledge of women with a wide range of rheumatic diseases. Methods The 10-item multiple-choice questionnaire was developed with feedback from a panel of content experts and female patients with rheumatic diseases. Construct validity using known-groups analysis was evaluated through comparison of median total ReproKnow scores between rheumatology fellows and nurses. Female patients aged 18–50 years were recruited to take ReproKnow and demographic questionnaires in two outpatient clinics. Associations between patients’ mean total knowledge scores and demographic characteristics were assessed using independent-sample t-tests. Questions were also categorized by topical area, and the percentages were calculated. Results The completion rate of questions in ReproKnow was 100% across all users. Median ReproKnow scores were significantly higher among rheumatology fellows than among nurses (p = 0.045). The 153 patients recruited to the study had at least one of 15 rheumatic diseases. Patients’ mean knowledge score was 5.05 (SD 2.24) out of a possible high score of 10. Patients who were younger, White, and more educated had significantly higher scores than did other patients (p’s < 0.05). Patients who bore children after their disease diagnosis had higher knowledge scores than did women whose children were born prior to their diagnosis; in contrast, women with histories of surgical sterilization or hysterectomy had lower knowledge scores than other women. Knowledge scores of women who used potentially fetotoxic medications did not vary from the remainder of the sample. Patients demonstrated gaps in knowledge about birth outcomes, contraceptive efficacy, and breastfeeding safety. Conclusions Initial testing of ReproKnow suggests that it may be a promising tool to assess the reproductive health knowledge of women with diverse rheumatic diseases. Specific knowledge deficits elicited from ReproKnow may be important targets for future educational interventions.
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Affiliation(s)
- Mehret Birru Talabi
- 1Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261 USA
| | | | - Susan J Blalock
- 3University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC USA
| | - Galen Switzer
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Lan Yu
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Alaina Chodoff
- 5Division of General Internal Medicine, University of Pittsburgh and UPMC, Pittsburgh, PA USA
| | - Sonya Borrero
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA.,Veteran's Affairs Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA USA
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Ehrenreich K, Kriz R, Grossman D. Miscarriage information available on the internet: a content analysis of leading consumer websites. Contracept X 2019; 1:100010. [PMID: 32550527 PMCID: PMC7286151 DOI: 10.1016/j.conx.2019.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The objective of this content analysis was to explore the accuracy and completeness of information provided about miscarriage on consumer-facing websites. STUDY DESIGN We identified the most popular consumer websites for health information and the leading medical and nursing professional association websites. We reviewed each website for content on miscarriage aimed at consumers and compared the website content to the information contained in the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on Early Pregnancy Loss. We used a simple scoring method to compare the accuracy and completeness of the content on each website with the ACOG Practice Bulletin. RESULTS Sixty percent (n = 9) of the top 15 consumer websites for health information had dedicated webpages on miscarriage. Of the nine leading professional association websites, two had dedicated pages on miscarriage. On average, each site provided information on 64% of the key messages from the ACOG Practice Bulletin. Sites commonly emphasized and provided overall accurate and complete information on risk factors of miscarriage. The key messages with the most limited or inaccurate information pertained to diagnosis of miscarriage; treatment, including medical management with mifepristone and misoprostol; instructions postmiscarriage and prevention of miscarriage. CONCLUSIONS The majority of popular health websites include consumer-facing content on miscarriage, and the information presented is a mostly complete and accurate representation of the ACOG Practice Bulletin. The lack of information on treatment options may affect patients' ability to make informed choices about their care. The missing information points to areas that patients may feel underprepared to discuss with healthcare providers. IMPLICATIONS More effort is needed to ensure that internet-based consumer information about miscarriage reflects the best scientific evidence.
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Affiliation(s)
- Katherine Ehrenreich
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, United States, 94612
| | - Rebecca Kriz
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
- California Preterm Birth Initiative, University of California, San Francisco
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Patient Decision Aid (PDA) for Patients with Rheumatoid Arthritis Reduces Decisional Conflict and Improves Readiness for Treatment Decision Making. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 13:57-69. [PMID: 31410723 PMCID: PMC6957559 DOI: 10.1007/s40271-019-00381-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives The aim of this study was to develop and assess the effectiveness of a patient decision aid (PDA) to support treatment decision making in Spanish patients with moderate-to-severe rheumatoid arthritis (RA) who fail to achieve the therapeutic goal with the current disease-modifying antirheumatic treatment strategy. Methods The PDA was developed in accordance with the International Patient Decision Aids Standards recommendations. A steering group led the project. Three literature reviews and two focus groups were performed to develop the PDA prototype. To check its comprehensibility, acceptability, and feasibility, alpha-testing was performed using the Decision Support Acceptability Scale (DSAS). Beta-testing was conducted to assess preliminary evidence of PDA efficacy using the Decisional Conflict Scale (DCS) before and after PDA use. Readiness was evaluated using the Preparation for Decision Making Scale (PDMS). Results The PDA included (1) a brief description of RA, (2) treatment information, and (3) a values clarification section. Alpha-testing revealed that most patients considered that the information was presented in a good or excellent way and it could help clarify their values and facilitate treatment decision making. Most rheumatologists agreed that the PDA was easy to understand, to use, and allowed them to reach a shared decision. Beta-testing showed that PDA significantly reduced overall patients’ decisional conflict [33.2 (DE: 21.4) vs 24.6 (23.5); p < 0.001] and prepared the patient for decision making [PDMS: 67.5 (21.0)]. Conclusions We developed a PDA for Spanish patients with moderate-to-severe RA that reduces patients’ decisional conflict and increases their readiness for decision making. The use of this PDA in routine clinical practice may improve the quality of the decision-making process and the quality of the choices made. Electronic supplementary material The online version of this article (10.1007/s40271-019-00381-y) contains supplementary material, which is available to authorized users.
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Chew C, Rebić N, Baldwin C, Amiri N, Proulx L, De Vera MA. "r/Thritis", Pregnancy, and Parenting: A Qualitative Descriptive Study of Reddit Forums to Explore Information Needs and Concerns of Women With Rheumatoid Arthritis. ACR Open Rheumatol 2019; 1:485-492. [PMID: 31777829 PMCID: PMC6857968 DOI: 10.1002/acr2.11069] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/17/2019] [Indexed: 01/20/2023] Open
Abstract
Objective Rheumatoid arthritis (RA) disproportionately affects more women than men, often striking during childbearing years. Because the Internet, particularly social media, is increasingly used by patients with chronic conditions seeking and sharing information, our objective was to conduct a qualitative descriptive study of threads on the social news website, Reddit, to understand the information needs and concerns of women with RA regarding pregnancy and parenting. Methods We searched threads (original posts and responses) on three subreddit sites, "r/Thritis," "r/Rheumatoid," and "r/BabyBumps," over a 10-year period between October 27, 2008, and October 27, 2018. All threads were reviewed, and those that specifically mentioned having RA and fertility/family planning, pregnancy/reproduction, and/or parenting/having children were included. We applied a thematic analysis to the threads, which involved initial line-by-line coding, clustering of codes into subcategories and categories, and abstraction into final themes. Results We identified 87 threads and included 59 for qualitative analysis. The thematic analysis led to the identification of five themes. Theme one (finding a community) captures motivations for seeking information online. Themes two (making decisions about pregnancy and having children) and three (worrying about the impacts of arthritis on pregnancy and parenting) capture women's concerns and thought processes. Themes four (information needs for managing arthritis throughout the perinatal period) and five (pregnancy information and resources for women with arthritis) describe the community's specific informational needs. Conclusion A qualitative analysis of publicly available threads about the relationship between RA and issues of pregnancy and parenting identified areas of concern and further information need. These forums also provided an online community where women with RA sought social support and encouragement. Altogether, findings speak to the importance of supporting the information and care needs of women with RA who are pregnant or considering pregnancy.
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Affiliation(s)
- Caitlin Chew
- Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Nevena Rebić
- Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Neda Amiri
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
| | - Mary A De Vera
- Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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19
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Birru Talabi M, Clowse MEB, Blalock SJ, Moreland L, Siripong N, Borrero S. Contraception Use Among Reproductive-Age Women With Rheumatic Diseases. Arthritis Care Res (Hoboken) 2019; 71:1132-1140. [PMID: 30106516 DOI: 10.1002/acr.23724] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 08/07/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine contraception use among a cohort of reproductive-age women (ages 18-50 years) with rheumatic diseases. METHODS We conducted a study of administrative data from a single, large medical center between the years 2013 and 2014. Women who had 1 of 21 possible rheumatic disease diagnoses and had at least 2 outpatient rheumatology visits were included in this analysis. We used logistic regression analyses to evaluate adjusted associations between the use of prescription contraception, use of potentially fetotoxic medications, and visits with rheumatologists, primary care providers, and gynecologists. RESULTS Of 2,455 women in this sample, 32.1% received any prescription contraception, and 7.9% of women used highly effective prescription methods (intrauterine devices, implants, and surgical sterilization). More than 70% of women took ≥1 type of fetotoxic medication during the 2-year study timeframe. Fetotoxic medication use was not associated with overall use of prescription contraception, but was associated with the use of highly effective contraceptive methods (adjusted odds ratio [OR] 2.26 [95% confidence interval (95% CI) 1.44-3.54]). Women who saw gynecologists or primary care providers were more likely to use prescription contraception overall (adjusted OR 3.35 [95% CI 2.77-4.05] and 1.43 [95% CI 1.18-1.73], respectively). Women who saw gynecologists were more likely to use highly versus moderately effective contraceptive methods (adjusted OR 2.35 [95% CI 1.41-3.94]). Rheumatology visits were not associated with use of prescription contraception in any models. CONCLUSION This is the largest study to date to describe contraceptive use among reproductive-age women with rheumatic diseases, and the findings reveal low use of prescription contraception. Urgent efforts are needed to improve contraceptive care and access for some women with rheumatic diseases.
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Affiliation(s)
| | | | - Susan J Blalock
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | | | | | - Sonya Borrero
- University of Pittsburgh and Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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20
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Singh JA, Fraenkel L, Green C, Alarcón GS, Barton JL, Saag KG, Hanrahan LM, Raymond SC, Kimberly RP, Leong AL, Reyes E, Street RL, Suarez-Almazor ME, Eakin GS, Marrow L, Morgan CJ, Caro B, Sloan JA, Jandali B, Garcia SR, Grossman J, Winthrop KL, Trupin L, Dall’Era M, Meara A, Rizvi T, Chatham WW, Yazdany J. Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial. PLoS Med 2019; 16:e1002800. [PMID: 31067237 PMCID: PMC6505936 DOI: 10.1371/journal.pmed.1002800] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Treatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis. METHODS AND FINDINGS In a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of <$40,000, and 36% had a high school education or less. Compared with the provision of the ACR lupus pamphlet (n = 147), participants randomized to the decision aid (n = 151) had (1) a clinically meaningful and statistically significant reduction in decisional conflict, 21.8 (standard error [SE], 2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed choice in the main analysis, 41% versus 31% (p = 0.08), but clinically meaningful and statistically significant difference in sensitivity analysis (net values for immunosuppressives positive [in favor] versus negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional conflict was lower in the decision aid versus pamphlet groups, 22% versus 44% (p < 0.001). Significantly more patients in the decision aid versus pamphlet group rated information to be excellent for understanding lupus nephritis (49% versus 33%), risk factors (43% versus 27%), medication options (50% versus 33%; p ≤ 0.003 for all); and the ease of use of materials was higher in the decision aid versus pamphlet groups (51% versus 38%; p = 0.006). Key study limitations were the exclusion of men, short follow-up, and the lack of clinical outcomes, including medication adherence. CONCLUSIONS An individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis. TRIAL REGISTRATION Clinicaltrials.gov, NCT02319525.
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Affiliation(s)
- Jasvinder A. Singh
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Birmingham VA Medical Center, Birmingham, Alabama, United States of America
- * E-mail:
| | - Liana Fraenkel
- Yale University, New Haven, Connecticut, United States of America
| | - Candace Green
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Graciela S. Alarcón
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jennifer L. Barton
- Oregon Health Science University, Portland, Oregon, United States of America
- VA Portland Health Care System, Portland, Oregon, United States of America
| | - Kenneth G. Saag
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | | | - Sandra C. Raymond
- Lupus Foundation of America, Washington, DC, United States of America
| | - Robert P. Kimberly
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amye L. Leong
- Healthy Motivation, Inc., Los Angeles, California, United States of America
| | - Elyse Reyes
- Elyse Reyes Consulting, Los Angeles, California, United States of America
| | - Richard L. Street
- Texas A&M University, College Station, Texas, United States of America
| | | | - Guy S. Eakin
- Arthritis Foundation, Atlanta, Georgia, United States of America
| | - Laura Marrow
- Arthritis Foundation, Atlanta, Georgia, United States of America
| | - Charity J. Morgan
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Brennda Caro
- Georgia State University, Atlanta, Georgia, United States of America
| | - Jeffrey A. Sloan
- Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Bochra Jandali
- Baylor College of Medicine, Houston, Texas, United States of America
| | | | - Jennifer Grossman
- University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Kevin L. Winthrop
- Oregon Health Science University, Portland, Oregon, United States of America
| | - Laura Trupin
- University of California at San Francisco (UCSF), San Francisco, California, United States of America
| | - Maria Dall’Era
- University of California at San Francisco (UCSF), San Francisco, California, United States of America
| | - Alexa Meara
- Ohio State University, Columbus, Ohio, United States of America
| | - Tara Rizvi
- Baylor College of Medicine, Houston, Texas, United States of America
| | - W. Winn Chatham
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jinoos Yazdany
- University of California at San Francisco (UCSF), San Francisco, California, United States of America
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Phillips R, Pell B, Grant A, Bowen D, Sanders J, Taylor A, Edwards A, Choy E, Williams D. Identifying the unmet information and support needs of women with autoimmune rheumatic diseases during pregnancy planning, pregnancy and early parenting: mixed-methods study. BMC Rheumatol 2018; 2:21. [PMID: 30886972 PMCID: PMC6390539 DOI: 10.1186/s41927-018-0029-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/25/2018] [Indexed: 01/26/2023] Open
Abstract
Background Autoimmune rheumatic diseases (ARDs) such as inflammatory arthritis and Lupus, and many of the treatments for these diseases, can have a detrimental impact on fertility and pregnancy outcomes. Disease activity and organ damage as a result of ARDs can affect maternal and foetal outcomes. The safety and acceptability of hormonal contraceptives can also be affected. The objective of this study was to identify the information and support needs of women with ARDs during pregnancy planning, pregnancy and early parenting. Methods This mixed methods study included a cross-sectional online survey and qualitative narrative interviews. The survey was completed by 128 women, aged 18–49 in the United Kingdom with an ARD who were thinking of getting pregnant in the next five years, who were pregnant, or had young children (< 5 years old). The survey assessed quality-of-life and information needs (Arthritis Impact Measurement Scale Short Form and Educational Needs Assessment Tool), support received, what women found challenging, what was helpful, and support women would have liked. From the survey participants, a maximum variation sample of 22 women were purposively recruited for qualitative interviews. Interviews used a person-centered participatory approach facilitated by visual methods, which enabled participants to reflect on their experiences. Interviews were also carried out with seven health professionals purposively sampled from primary care, secondary care, maternity, and health visiting services. Results Survey findings indicated an unmet need for information in this population (ENAT total mean 104.85, SD 30.18). Women at the pre-conception stage reported higher needs for information on pregnancy planning, fertility, giving birth, and breastfeeding, whereas those who had children already expressed a higher need for information on pain and mobility. The need for high quality information, and more holistic, multi-disciplinary, collaborative, and integrated care consistently emerged as themes in the survey open text responses and interviews with women and health professionals. Conclusions There is an urgent need to develop and evaluate interventions to better inform, support and empower women of reproductive age who have ARDs as they navigate the complex challenges that they face during pregnancy planning, pregnancy and early parenting. Electronic supplementary material The online version of this article (10.1186/s41927-018-0029-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rhiannon Phillips
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Bethan Pell
- 2Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Aimee Grant
- 2Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Daniel Bowen
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- 3School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Taylor
- 4Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ernest Choy
- 5Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Denitza Williams
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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22
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Phillips R, Williams D, Bowen D, Morris D, Grant A, Pell B, Sanders J, Taylor A, Choy E, Edwards A. Reaching a consensus on research priorities for supporting women with autoimmune rheumatic diseases during pre-conception, pregnancy and early parenting: A Nominal Group Technique exercise with lay and professional stakeholders. Wellcome Open Res 2018; 3:75. [PMID: 30191184 PMCID: PMC6092904 DOI: 10.12688/wellcomeopenres.14658.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 02/01/2023] Open
Abstract
Background:Women with autoimmune rheumatic diseases (ARDs) find it difficult to get information and support with family planning, pregnancy, and early parenting. A systematic approach to prioritising research is required to accelerate development and evaluation of interventions to meet the complex needs of this population. Methods:A Nominal Group Technique (NGT) exercise was carried out with lay and professional stakeholders (n=29). Stakeholders were prepared for debate through presentation of available evidence. Stakeholders completed three tasks to develop, individually rank, and reach consensus on research priorities: Task 1 - mapping challenges and services using visual timelines; Task 2 - identifying research topics; Task 3 - individually ranking research topics in priority order. Results of the ranking exercise were fed back to the group for comment. Results:The main themes emerging from Task 1 were the need for provision of information, multi-disciplinary care, and social and peer support. In Task 2, 15 research topics and 58 sub-topics were identified around addressing the challenges and gaps in care identified during Task 1. In Task 3, a consensus was reached on the ten research topics that should be given the highest priority. These were individually ranked, resulting in the following order of priorities (from 1 - highest to 10 - lowest): 1. Shared decision-making early in the care pathway; 2. Pre-conception counseling; 3. Information about medication use during pregnancy/breastfeeding; 4. Personalised care planning; 5. Support for partners/family members; 6. Information about local support/disease specific issues; 7. Shared decision-making across the care pathway; 8. Peer-support; 9. Social inequalities in care, and; 10. Guidance on holistic/alternative therapies. Conclusions:This systematic approach to identification of research priorities from a multi-disciplinary and lay perspective indicated that activities should focus on development and evaluation of interventions that increase patient involvement in clinical decision-making, multi-disciplinary models of care, and timely provision of information.
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Affiliation(s)
| | - Denitza Williams
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Daniel Bowen
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Delyth Morris
- University Library Service, Cardiff University, Cardiff, UK
| | - Aimee Grant
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Bethan Pell
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Taylor
- Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Ernest Choy
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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23
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McGrath A, Sharpe L, Lah S, Parratt K. Evaluation of a Decision Aid for Women with Epilepsy Who Are Considering Pregnancy: A Randomized Controlled Trial. Med Decis Making 2017; 37:589-599. [PMID: 28590833 DOI: 10.1177/0272989x17697304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND For many women with epilepsy (WWE), decision making about pregnancy is complicated by considerations such as the potential teratogenicity of antiepileptic drugs, offspring risk of epilepsy, seizure occurrence during pregnancy, and the challenges of parenting amidst poorly controlled seizures. OBJECTIVE This proof-of-concept, randomized controlled trial aimed to evaluate a decision aid (DA) developed to help WWE decide if they should start or enlarge their families. METHODS Seventy-nine WWE of childbearing age were recruited from Epilepsy Action Australia between October and November 2013 and randomized to receive the intervention (the DA) or not, and to complete a set of questionnaires pre- and post- intervention. The DA, delivered as a PDF booklet, provided balanced evidence-based information about options, risks and benefits, including probabilities; as well as steps for clarifying values and considering options within one's personal situation. RESULTS Compared with the control group, the DA group had statistically significant improvements in knowledge about pregnancy and epilepsy (Cohen's d = 1.24; 95%CI = 0.77 to 1.83) and reduced decisional conflict (Cohen's d = 0.59; 95%CI = 0.21 to 0.99). Changes in decision self-efficacy, certainty of choice, patient-practitioner communication abilities and value congruence with choice were comparable between the DA and control group. Importantly, women's decisions about motherhood were not biased towards either direction, and there were no adverse effects on depression or anxiety. All women who received the DA indicated they would recommend it to other WWE. CONCLUSIONS The DA has the potential to serve as a useful support tool for WWE who are considering motherhood. Future research is needed to test the DA in clinical settings with guidance from a health professional. The trial was registered with the Australian New Zealand Clinical Trials Registry (ID ACTRN12613001082796).
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Affiliation(s)
- Amanda McGrath
- The School of Psychology, University of Sydney (AM, LS, SL)
| | - Louise Sharpe
- The School of Psychology, University of Sydney (AM, LS, SL)
| | - Suncica Lah
- The School of Psychology, University of Sydney (AM, LS, SL)
- ARC Centre of Excellence in Cognition and its Disorders (SL)
| | - Kaitlyn Parratt
- Comprehensive Epilepsy Service, Royal Prince Alfred Hospital (KP)
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24
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Korteland NM, Ahmed Y, Koolbergen DR, Brouwer M, de Heer F, Kluin J, Bruggemans EF, Klautz RJM, Stiggelbout AM, Bucx JJJ, Roos-Hesselink JW, Polak P, Markou T, van den Broek I, Ligthart R, Bogers AJJC, Takkenberg JJM. Does the Use of a Decision Aid Improve Decision Making in Prosthetic Heart Valve Selection? A Multicenter Randomized Trial. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003178. [PMID: 28228452 DOI: 10.1161/circoutcomes.116.003178] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/10/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND A Dutch online patient decision aid to support prosthetic heart valve selection was recently developed. A multicenter randomized controlled trial was conducted to assess whether use of the patient decision aid results in optimization of shared decision making in prosthetic heart valve selection. METHODS AND RESULTS In a 5-center randomized controlled trial, patients were allocated to receive either standard preoperative care (control group) or additional access to the patient decision aid (intervention group). Legally capable adult patients accepted for elective isolated or combined aortic and mitral valve replacement were included. Primary outcome was preoperative decisional conflict (Decisional Conflict Scale); secondary outcomes included patient knowledge, involvement in valve selection, anxiety and depression, (valve-specific) quality of life, and regret. Out of 306 eligible patients, 155 were randomized (78 control and 77 intervention). Preoperative decisional conflict did not differ between the groups (34% versus 33%; P=0.834). Intervention patients felt better informed (median Decisional Conflict Scale informed subscore: 8 versus 17; P=0.046) and had a better knowledge of prosthetic valves (85% versus 68%; P=0.004). Intervention patients experienced less anxiety and depression (median Hospital Anxiety and Depression Scale score: 6 versus 9; P=0.015) and better mental well-being (mean Short Form Health Survey score: 54 versus 50; P=0.032). Three months postoperatively, valve-specific quality of life and regret did not differ between the groups. CONCLUSIONS A patient decision aid to support shared decision making in prosthetic heart valve selection does not lower decisional conflict. It does result in more knowledgeable, better informed, and less anxious and depressed patients, with a better mental well-being. CLINICAL TRIAL REGISTRATION http://www.trialregister.nl. Unique identifier: NTR4350.
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Affiliation(s)
- Nelleke M Korteland
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Yunus Ahmed
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - David R Koolbergen
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Marjan Brouwer
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Frederiek de Heer
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Jolanda Kluin
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Eline F Bruggemans
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Robert J M Klautz
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Anne M Stiggelbout
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Jeroen J J Bucx
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Jolien W Roos-Hesselink
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Peter Polak
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Thanasie Markou
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Inge van den Broek
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Rene Ligthart
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Ad J J C Bogers
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Johanna J M Takkenberg
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.).
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Blalock SJ. Medication Risk Communication in Rheumatology: Where Are We and Where Do We Go from Here? Curr Rheumatol Rep 2017; 19:7. [PMID: 28164248 DOI: 10.1007/s11926-017-0631-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper reviews findings from recent research examining issues related to the risk communication process within the context of rheumatologic conditions. Five specific questions are addressed. First, to what extent do patients with rheumatic disorders exhibit adequate knowledge relevant to disease and medication risks and risk management? Second, what sources do patients use when attempting to find information about disease and medication risks and risk management? Third, what types of information about disease and medication risks and risk management do rheumatologists provide during routine office visits. Fourth, what governmental regulations attempt to increase consumer access to information about medication risks and risk management? Finally, what other educational resources are available to facilitate patient-provider communication concerning disease and medication risks and risk management? The findings reported identify gaps in patient knowledge concerning medication risks and risk management, highlight areas for improvement, and identify resources that may enhance medication risk communication.
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Affiliation(s)
- Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7573, USA.
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Ralph LJ, Foster DG, Kimport K, Turok D, Roberts SCM. Measuring decisional certainty among women seeking abortion. Contraception 2016; 95:269-278. [PMID: 27745910 DOI: 10.1016/j.contraception.2016.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy. METHODS Eligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews 3 weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at follow-up. RESULTS Five hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=.93 and .72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses. CONCLUSION The DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care. Comparing scores on the DCS in this population to other studies of decision making suggests that the level of uncertainty in abortion decision making is comparable to or lower than other health decisions. IMPLICATIONS The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.
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Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - David Turok
- University of Utah, Department of Obstetrics and Gynecology, 50 N Medical Dr, Salt Lake City, UT 84132, USA.
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
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Ackerman IN, Briggs AM, Ngian GS, Van Doornum S. Closing the pregnancy-related information gap for women with rheumatoid arthritis. Rheumatology (Oxford) 2016; 55:1343-4. [DOI: 10.1093/rheumatology/kew024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/13/2022] Open
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Ackerman IN, Ngian GS, Van Doornum S, Briggs AM. A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis. Clin Rheumatol 2015; 35:33-41. [DOI: 10.1007/s10067-015-3131-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 12/16/2022]
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