Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada.
Garry Hurvitz Centre for Brain and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
BMC Med Inform Decis Mak. 2022 May 13;22(1):130. doi: 10.1186/s12911-022-01870-1.
People with moderate to severe depression in pregnancy must weigh potential risks of untreated or incompletely treated depression against the small, but uncertain risks of fetal antidepressant drug exposure. Clinical support alone appears insufficient for helping individuals with this complex decision. A patient decision aid (PDA) has the potential to be a useful tool for this population. The objective of our work was to use internationally recognized guidelines from the International Patient Decision Aids Standards Collaboration to develop an evidence-based PDA for antidepressant use in pregnancy.
A three-phased development process was used whereby, informed by patient and physician perspectives and evidence synthesis, a steering committee commissioned a web-based PDA for those deciding whether or not to start or continue antidepressant treatment for depression in pregnancy (Phase 1). A prototype was developed (Phase 2) and iteratively revised based on feedback during field testing based on a user-centred process (Phase 3).
We developed a web-based PDA for people deciding whether to start or continue antidepressant use for depression in pregnancy. It has five interactive sections: (1) information on depression and treatment; (2) reasons to start/continue an antidepressant and to start/stop antidepressant medication; (3) user assessment of values regarding each issue; (4) opportunity to reflect on factors that contribute to decision making; and (5) a printable PDF that summarizes the user's journey through the PDA.
This tool, which exclusively focuses on depression treatment with Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors, can be used by individuals making decisions about antidepressant use to treat depression during pregnancy. Limitations of the PDA are that it is not for other conditions, nor other medications that can be used for depression, and in its pilot form cannot be used by women who do not speak English or who have a visual impairment. Pending further study, it has the potential to enhance quality of care and patient experience.
患有中度至重度抑郁症的孕妇必须权衡未治疗或治疗不充分的抑郁症的潜在风险与胎儿暴露于抗抑郁药物的微小但不确定的风险。仅依靠临床支持似乎不足以帮助个人做出这一复杂的决策。患者决策辅助工具（PDA）有可能成为该人群的有用工具。我们的工作目标是使用国际患者决策辅助工具标准协作组织的国际公认指南来开发针对妊娠期间使用抗抑郁药的基于证据的 PDA。
采用分三个阶段的开发过程，即根据患者和医生的观点以及证据综合，指导委员会委托开发了一个针对那些决定是否开始或继续抗抑郁药治疗妊娠期间抑郁症的在线 PDA（第 1 阶段）。根据基于用户为中心的过程的现场测试中的反馈，开发了一个原型（第 2 阶段），并进行了迭代修订（第 3 阶段）。
我们开发了一个针对决定是否开始或继续抗抑郁药治疗妊娠期间抑郁症的在线 PDA。它有五个交互部分：（1）关于抑郁症和治疗的信息；（2）开始/继续使用抗抑郁药和开始/停止抗抑郁药的原因；（3）用户对每个问题的价值观评估；（4）有机会反思决策的影响因素；（5）一个可打印的 PDF 摘要，总结用户在 PDA 中的决策过程。
这个工具专门针对使用选择性 5-羟色胺再摄取抑制剂和 5-羟色胺-去甲肾上腺素再摄取抑制剂治疗抑郁症，个人可以使用它来做出关于使用抗抑郁药治疗妊娠期间抑郁症的决策。该 PDA 的局限性在于它不适用于其他疾病，也不适用于其他可用于治疗抑郁症的药物，并且在其试点形式下，不适合不会讲英语或视力有障碍的女性使用。在进一步研究之前，它有可能提高护理质量和患者体验。
