The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy

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

doi:10.1186/s12911-022-01870-1

The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy

BMC Med Inform Decis Mak. 2022 May 13;22(1):130. doi: 10.1186/s12911-022-01870-1.

Authors

Neesha Hussain-Shamsy¹, Sarah Somerton², Donna E Stewart^{3

4}, Sophie Grigoriadis^{4

5

6}, Kelly Metcalfe^{6

7}, Tim F Oberlander^{8

9}, Carrie Schram⁶, Valerie H Taylor¹⁰, Cindy-Lee Dennis⁷, Simone N Vigod^{11

12

13}

Affiliations

¹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada.
² Garry Hurvitz Centre for Brain and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
³ Centre for Mental Health, University Health Network, Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, Canada.
⁴ Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.
⁵ Sunnybrook Health Sciences Centre and Research Institute, 2075 Bayview Avenue, Toronto, ON, Canada.
⁶ Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
⁷ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada.
⁸ BC Children's Hospital, 4500 Oak Street, Vancouver, BC, Canada.
⁹ Department of Pediatrics, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada.
¹⁰ Department of Psychiatry, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada. simone.vigod@wchospital.ca.
¹² Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada. simone.vigod@wchospital.ca.
¹³ Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. simone.vigod@wchospital.ca.

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.

Keywords: Antidepressant; Depression; Online; Patient decision aid; Pregnancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antidepressive Agents / therapeutic use
Decision Making
Decision Support Techniques*
Female
Humans
Patient Participation*
Pregnancy

Substances

Antidepressive Agents