Charles E. Schmidt College of Medicine, Florida Atlantic University , Boca Raton , FL , USA.
George Washington University , Washington, DC , USA.
Subst Use Misuse. 2019;54(13):2241-2250. doi: 10.1080/10826084.2019.1644524. Epub 2019 Jul 26.
: The incidence of pregnant women with an opioid use disorder (PWOUD) at delivery has quadrupled since 1999. State-specific statutes regarding PWOUD often pose punitive measures to the mother-infant dyad, involving the child welfare and criminal justice systems. Shared decision making (SDM) assists individuals through complex health and recovery processes. : To determine use of SDM in treating PWOUD and associated factors and to quantify physicians' review and discussion of child welfare statutes. : The American College of Obstetricians and Gynecologists (ACOG) e-mailed the survey to a random sample of members, with 568 responding. Bivariate analyses to identify factors associated with each outcome were performed using Wilcoxon Rank Sum tests or Fisher's Exact tests. Variables yielding values < .20 were included in initial logistic regression models; the final model included only significant (<.05) variables. : Sixty-one percent used SDM most of the time. Logistic regression indicated that those using SDM were more likely to have had training in substance use disorder and felt prepared for caring for PWOUD; 39% reviewed statutes, and 54% discussed them with PWOUDs. Survey results provide evidence for patient-centered care approaches that support PWOUD involvement in treatment decision making. The SDM model provides an empowerment framework for women to be involved in the process during their pregnancies and opioid use disorder treatments. Future studies might assess the effectiveness of SDM dialogs with PWOUD and evaluate CME training and medical curricula regarding the SDM model.
：自 1999 年以来，分娩时患有阿片类药物使用障碍（PWOUD）的孕妇的发病率增加了四倍。各州关于 PWOUD 的具体法规通常对母婴对子施加惩罚措施，涉及儿童福利和刑事司法系统。共同决策（SDM）通过复杂的健康和康复过程来帮助个人。
：确定在治疗 PWOUD 中使用 SDM 及其相关因素，并量化医生对儿童福利法规的审查和讨论。
：美国妇产科医师学会（ACOG）向其成员的随机样本发送了电子邮件调查，其中 568 人做出了回应。使用 Wilcoxon 秩和检验或 Fisher 精确检验对每个结果进行 bivariate 分析，以确定与每个结果相关的因素。产生 值 <.20 的变量被包括在初始逻辑回归模型中；最终模型仅包括具有统计学意义的（<.05）变量。
：61%的人大部分时间使用 SDM。逻辑回归表明，使用 SDM 的人更有可能接受过物质使用障碍方面的培训，并且对照顾 PWOUD 有准备；39%的人审查了法规，54%的人与 PWOUD 讨论了法规。调查结果为以患者为中心的护理方法提供了证据，这些方法支持 PWOUD 参与治疗决策。SDM 模型为女性提供了一个赋权框架，使她们能够在怀孕期间和阿片类药物使用障碍治疗过程中参与进来。未来的研究可能会评估与 PWOUD 进行 SDM 对话的有效性，并评估关于 SDM 模型的 CME 培训和医学课程。
