A new shared decision-making tool helps women in recovery from opioid use disorder (OUD) decide whether or not to continue buprenorphine or methadone treatments during pregnancy, according to research results published in Psychiatric Research and Clinical Practice.
There has been a significant increase in opioid use during pregnancy in the United States and researchers sought to develop a clinical tool for healthcare providers to help pregnant women with OUD make informed decisions.
In accordance with the International Patient Decision Aid Standards (IPDAS), researchers developed a shared decision-making aid and examined pregnant women who subsequently made a decision to continue or taper pharmacotherapy for the treatment of OUD. After using the aid, 22 women receiving care at an outpatient obstetrics clinic completed a survey about how the aid adhered to IPDAS principles.
After using the shared decision-making aid, 95% of women reported making a clear decision to either continue or taper buprenorphine or methadone. Of the total study participants, 64% chose to continue therapy and 36% chose to taper their pharmacotherapy treatment of OUD. Participants reported that they were provided with adequate medical information (96%), outcome probabilities (91%), and decision guidance (86% to 95%) that helped them to make an informed decision about their treatment. Women also overwhelmingly reported (77% to 91%) that their choice reflected their values and preferences.
Of the women taking methadone, 33% decided to taper the medication. In addition, of the women taking buprenorphine, 37% decided to taper the medication. Some of the common reasons for tapering were neonatal opioid withdrawal syndrome, stigma, and fear of withdrawal during the postpartum period because they might not be able to afford the medication postpartum. The most common reason patients chose to continue the medication were risk for relapse due to illicit drug use and the belief that opioid withdrawal during pregnancy could harm the baby.
The study was limited by a lack of randomization and of a validated anxiety measure or patient satisfaction survey. In addition, the study would have benefitted from a rating scale assessing the utility of the decision aid.
The study illustrates the efficacy of this shared decision-making aid in reducing decisional conflict over continuing or tapering pharmacotherapy treatment during pregnancy. The researchers concluded that this tool is a useful aid in “ensuring that women with OUD have the opportunity to make informed, evidence-based decisions that support their individual values and preferences and that are ultimately optimal for themselves and their families.”
Guille C, Jones HE, Abuhamad A, Brady KT. Shared decision-making tool for treatment of perinatal opioid use disorder. PRCP in advance [published online January 8, 2019]. Psychiatric Research & Clinical Practice. doi:10.1176/appi.prcp.20180004