Shared decision making is widely accepted as an ideal in patient-centered care. To facilitate meaningful discussions about opioid use disorder (OUD) during pregnancy, a shared decision-making approach is crucial. This process involves informed patient education and a collaborative discussion between healthcare providers and pregnant patients. Patient decision aids can be a valuable adjunct to clinical care. Decision aids in Obstetric care have been used for other situations such as use of analgesia during labor, decision to try vaginal birth, etc.
It is imperative to begin with comprehensive patient education. Pregnant individuals should be informed about the potential risks and benefits associated with various treatment options for perinatal OUD. This includes an understanding of the risks associated with medically supervised withdrawal. Please see attached the SAMSHA patient fact sheet for OUD and Pregnancy to help providers with the patient education process.
A valuable resource for healthcare providers is a shared decision-making tool designed specifically for perinatal OUD. This tool outlines the maternal, fetal, and newborn risks associated with methadone and buprenorphine treatment, as well as the risks of tapering or discontinuing these medications during pregnancy. 95% of women who utilized the tool with their healthcare providers were able to arrive at a treatment decision regarding their medication choice. For those interested in exploring the shared-decision making tool further, a link to the tool is available for free in the online supplement, allowing healthcare providers to access this valuable resource to support their discussions with pregnant patients dealing with OUD during pregnancy.
- Saira Kalia, MD