Filtering by
- All Subjects: decision making
- All Subjects: Opioid-Related Disorders
- All Subjects: Syphilis
- Creators: Link, Denise
- Resource Type: Text
Opioid use disorder (OUD) is a chronic, complex health condition that continues to be a growing problem in the general population, and this increase is paralleled in pregnant women. Pregnancy is a time when women with OUD may be ready to begin a journey of recovery. OUD has both maternal and fetal implications. The safest way to begin recovery during pregnancy is with the initiation of either buprenorphine or methadone to prevent symptoms of withdrawal which can increase risk of fetal harm.
Both medications have the added benefit of being safe to use during lactation. There is a minimal amount of either medication that is found in breastmilk. Breastfeeding during medication assisted recovery (MAR) is linked both to improved maternal and neonatal outcomes, and improved bonding. Often women who are engaged in MAR are unaware of the benefits of breastfeeding initiation and exclusivity. Mothers may perceive breastfeeding as a danger to their baby based on misinformation and bias. Initiation of individualized and nonjudgmental breastfeeding education to women beginning an inpatient MAR program can improve maternal understanding of the benefits of exclusive breastfeeding and increase intention to exclusively breastfeed.
Vasomotor symptoms (VMS) associated with menopause vary greatly, as do the multitude of available treatment options. It can be difficult for clinicians to manage these symptoms while balancing patient safety concerns and preferences. Shared decision-making (SDM) can assist both the provider and patient to navigate the various treatment options, minimizing gaps between their preferences.
To assess the effect of SDM in a nurse-led practice in the Southwest, two nurse practitioners (NP) were invited to use a menopausal decision aid (DA). Women aged 40 to 64 years experiencing VMS were invited to participate in the project. Following a visit with the NP in which the DA was used, patients completed a six question post-intervention survey based on both the Decisional Conflict Scale (DCS) and SDM-Q-9 surveys. Patients were also asked to complete a telephone interview about the process 1-2 weeks post-intervention. The NP completed a post-intervention survey based on the SDM-Q-Doc to assess clinician satisfaction with the SDM process. Eight patients (mean age, 47.9 years), presenting with a range of 2 to 6 perimenopausal symptoms participated in the project.
All patients (100%) strongly or completely agreed that the clinician precisely explained the advantages & disadvantages of treatment options, helped them understand all the information, reached an agreement on how to proceed with care, and were extremely satisfied or satisfied with their decision and making an informed choice. Both clinicians completely agreed they had come to an agreement on how to proceed, and completely or strongly agreed they helped the patient understand all information. There was a correlation between the use of SDM patient’s age, making an informed choice, and being satisfied with their decision. Incorporating a perimenopausal DA can enhance patient and clinician satisfaction with SDM to understand their treatment options and make an informed menopausal decision.