Abstract
Background: There are clear educational pregnancy-related needs for both women and men living with Autoimmune Rheumatic Diseases (ARDs) who seek specific advice from their health care providers. Most of the time those subjects would seek specific information regarding their chances of pregnancy, impact of the disease, as well as safety of their medications during pregnancy and breast feeding. They also require emotional and physical support as well as advice towards practical coping strategies to manage pain and disease flares particularly during the postnatal period. Objectives: To evaluate the effectiveness of a new interactive pregnancy decision aid (DA) developed for both men and women living with inflammatory arthritis. Methods: Driven by the Cochrane review of patient decision aids (DA) and the International Patient Decision Aids framework (IPDAS), which identify shared decision making (SDM) instrument as evidence-based tools designed to help people engage in deliberative management-related decision making by providing information on the options and outcomes relevant to health status. This project involved an overall three-phase SDM aid development. It has been set up for both men and women and included information on pregnancy, contraception and breast feeding. The first phase included the development of the decision tool and review by expert faculty composed of: decision experts, patient representatives, policy makers, and patients living with RA, PsA, AS and SLE. The second phase was a pilot testing of the tool in both online and paper format styles. The third phase involved an evaluation of the decision support tool and its impact on the patients. The DA adopted an interactive style with embedded video recordings (this was converted into text in the paper format). All the patient completed these questionnaires: the ReproKnow, Decisional Conflict Scale (DCS), Hospital Anxiety and Depression Scale (HADS), and Arthritis Self-Efficacy Scale (ASES) pre- and post-intervention. A control group of 92 patients (19 men and 71 women) managed according to the standard protocols was also included. Comprehensibility of the video recordings were also assessed using VAS (0-10). Results: 126 patients shared in this work (101 women and 25 men). The patients who received the DA had an 81% (women) and 83% (men) increase in ReproKnow scores and a 76 % decrease in scores on the decisional conflict (DCS), compared to the control group (10 % and 11 % respectively); p< 0.001. There were no changes in the scores of depression and anxiety symptoms (p= 0.873) indicating no adverse psychological impact detected. There was no significant difference in terms of self-efficacy assessment p=0.481. The patients rated the comprehensibility of the video recording as high (9.4/10) Conclusion: The DA which was developed to support pregnancy and breast feeding decision-making for patients with ARDs. The interactive SDM aid was found to be a simple, user-friendly tool which can be implemented in standard clinical practice. The interactive style made it more comprehensible to the patients. It is consistent with the IPDAS criteria. Results revealed its effectiveness in improving relevant knowledge and reducing decisional conflict without causing distress to the patients. Disclosure of Interests: None declared.