(468) Formative Research about Shared Decision-Making in the Treatment of Opioid Use Disorder in Pregnant Women

Objective : Shared decision-making (SDM) is infrequent in the care of Pregnant Women with Opioid Use Disorders (PWOUD). We aimed to 1) identify content related to Medication Assisted Treatment (MAT) for inclusion in a patient education tool and 2) identify barriers and facilitators to SDM in the treatment of PWOUD.

Methods: We performed a preliminary review of the literature in September 2021. Based on the review findings, we developed an educational tool for use in SDM with PWOUD. Subsequently, we recruited clinicians and doulas (n=19) who care for PWOUD and conducted semi-structured interviews to obtain their perspectives on the educational tool and the SDM process. We also asked participants about factors affecting the use of SDM in the care of PWOUD. An interdisciplinary coding team performed a thematic analysis of the interview data using NVivo.

Results: Findings from the review led to the inclusion of information on 1)benefits and risks associated with MAT versus No MAT, 2)Medications for Opioid Use Disorder (MOUD), and 3) MOUD while breastfeeding on a brochure. Three major themes related to the brochure emerged: 1) Suggested uses and settings of use, 2) Content revisions, and 3) Perceptions about the tool. Barriers to SDM included time constraints, lack of decision counseling tools at points of care, and patients presenting in an actively high state or withdrawing. Facilitators included the involvement of peer workers and other trained personnel, creating space and time for SDM, and training staff in SDM.

Conclusions: This study provides valuable insights into the diverse settings and potential applications of an educational tool describing treatment options for PWOUD. It also describes barriers and facilitators of SDM about initiating MAT for PWOUD.