Jeminiwa Ruth, Dadabaev Fadel, Kim Heeyoung, Gannon Megan, Myers Ronald, Abatemarco Diane J
Department of Pharmacy Practice, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, United States of America.
Jefferson College of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, United States of America.
J Subst Use Addict Treat. 2025 Jan;168:209526. doi: 10.1016/j.josat.2024.209526. Epub 2024 Sep 28.
Research about the application of shared decision-making (SDM) in the context of Medication Assisted Treatment (MAT) for pregnant women with opioid use disorder (OUD) is limited. The objectives of our study were to 1) examine facilitators of and barriers to SDM for the initiation of MAT in clinical practice and 2) evaluate the receptivity of clinicians and doulas involved in the care of women with OUD to the use of an online software application to facilitate SDM about MAT.
This qualitative study utilized semi-structured interviews with consenting physicians and doulas who provided care for pregnant women with OUD between November 2021 and May 2022. Participants were asked about factors influencing SDM in practice. In addition, the study asked participants about the feasibility of using the Jefferson Decision Counseling Guide© (JDCG) to educate pregnant women with OUD as to the benefits and risks of undergoing MAT versus no treatment and to help patients clarify their treatment preference. The study recorded the interview and transcribed it verbatim using Rev. transcription services. The study used thematic analyses to code the data and identify key barriers and facilitators of SDM and perceptions of the SDM tool.
Nineteen participants completed interviews. The study identified several barriers to SDM including time constraints, lack of decision counseling tools at points of care, and patients presenting in an actively high state or withdrawing. Peer workers or other trained personnel, giving patients more time, and comfort in decision counseling are examples of facilitators identified by the participants of the study. Participants believed that the counseling tool could facilitate conversations with patients and should be integrated into the workflow.
In this qualitative study, we identified several barriers and facilitators of SDM to initiate MAT for pregnant women with OUD. Our findings indicate that there are challenges and opportunities for healthcare systems to increase SDM in this marginalized patient population. Feedback from participants highlighted their receptivity to the use of SDM tools to facilitate meaningful conversations in various settings that can guide decision making about care.
关于共享决策（SDM）在患有阿片类物质使用障碍（OUD）的孕妇药物辅助治疗（MAT）背景下应用的研究有限。我们研究的目的是：1）探讨临床实践中启动MAT时SDM的促进因素和障碍；2）评估参与患有OUD妇女护理的临床医生和助产士对使用在线软件应用程序来促进MAT相关SDM的接受程度。
这项定性研究采用半结构化访谈，对象为2021年11月至2022年5月期间为患有OUD的孕妇提供护理的同意参与的医生和助产士。参与者被问及影响实践中SDM的因素。此外，该研究询问参与者使用杰斐逊决策咨询指南（JDCG）对患有OUD的孕妇进行教育，告知其接受MAT与不接受治疗的益处和风险，并帮助患者明确其治疗偏好的可行性。该研究对访谈进行录音，并使用Rev转录服务逐字转录。该研究使用主题分析对数据进行编码，确定SDM的关键障碍和促进因素以及对SDM工具的看法。
19名参与者完成了访谈。该研究确定了SDM的几个障碍，包括时间限制、护理点缺乏决策咨询工具，以及患者处于积极兴奋状态或正在戒断。同伴工作者或其他受过培训的人员、给患者更多时间以及决策咨询中的舒适度是该研究参与者确定的促进因素的例子。参与者认为咨询工具可以促进与患者的对话，应整合到工作流程中。
在这项定性研究中，我们确定了为患有OUD的孕妇启动MAT时SDM的几个障碍和促进因素。我们的研究结果表明，医疗保健系统在这个边缘化患者群体中增加SDM存在挑战和机遇。参与者的反馈突出了他们对使用SDM工具在各种环境中促进有意义对话的接受程度，这些对话可以指导护理决策。
