The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy
Abstract Background 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...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-05-01
|
| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12911-022-01870-1 |
| _version_ | 1828202644863188992 |
|---|---|
| author | Neesha Hussain-Shamsy Sarah Somerton Donna E. Stewart Sophie Grigoriadis Kelly Metcalfe Tim F. Oberlander Carrie Schram Valerie H. Taylor Cindy-Lee Dennis Simone N. Vigod |
| author_facet | Neesha Hussain-Shamsy Sarah Somerton Donna E. Stewart Sophie Grigoriadis Kelly Metcalfe Tim F. Oberlander Carrie Schram Valerie H. Taylor Cindy-Lee Dennis Simone N. Vigod |
| author_sort | Neesha Hussain-Shamsy |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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). Results 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. Conclusions 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. |
| first_indexed | 2024-04-12T11:52:09Z |
| format | Article |
| id | doaj.art-f127a977e1c546eb93620f7eb9202112 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-04-12T11:52:09Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-f127a977e1c546eb93620f7eb92021122022-12-22T03:34:09ZengBMCBMC Medical Informatics and Decision Making1472-69472022-05-012211910.1186/s12911-022-01870-1The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancyNeesha Hussain-Shamsy0Sarah Somerton1Donna E. Stewart2Sophie Grigoriadis3Kelly Metcalfe4Tim F. Oberlander5Carrie Schram6Valerie H. Taylor7Cindy-Lee Dennis8Simone N. Vigod9Institute of Health Policy, Management and Evaluation, University of TorontoGarry Hurvitz Centre for Brain and Mental Health, Hospital for Sick ChildrenCentre for Mental Health, University Health Network, Toronto General Hospital Research InstituteTemerty Faculty of Medicine, University of TorontoWomen’s College Hospital and Research InstituteBC Children’s HospitalWomen’s College Hospital and Research InstituteDepartment of Psychiatry, University of CalgaryLawrence S. Bloomberg Faculty of Nursing, University of TorontoInstitute of Health Policy, Management and Evaluation, University of TorontoAbstract Background 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. Methods 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). Results 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. Conclusions 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.https://doi.org/10.1186/s12911-022-01870-1Patient decision aidPregnancyAntidepressantDepressionOnline |
| spellingShingle | Neesha Hussain-Shamsy Sarah Somerton Donna E. Stewart Sophie Grigoriadis Kelly Metcalfe Tim F. Oberlander Carrie Schram Valerie H. Taylor Cindy-Lee Dennis Simone N. Vigod The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy BMC Medical Informatics and Decision Making Patient decision aid Pregnancy Antidepressant Depression Online |
| title | The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy |
| title_full | The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy |
| title_fullStr | The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy |
| title_full_unstemmed | The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy |
| title_short | The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy |
| title_sort | development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy |
| topic | Patient decision aid Pregnancy Antidepressant Depression Online |
| url | https://doi.org/10.1186/s12911-022-01870-1 |
| work_keys_str_mv | AT neeshahussainshamsy thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT sarahsomerton thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT donnaestewart thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT sophiegrigoriadis thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT kellymetcalfe thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT timfoberlander thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT carrieschram thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT valeriehtaylor thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT cindyleedennis thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT simonenvigod thedevelopmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT neeshahussainshamsy developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT sarahsomerton developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT donnaestewart developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT sophiegrigoriadis developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT kellymetcalfe developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT timfoberlander developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT carrieschram developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT valeriehtaylor developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT cindyleedennis developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy AT simonenvigod developmentofapatientdecisionaidtoreducedecisionalconflictaboutantidepressantuseinpregnancy |