OP0331-HPR BARRIERS TO SHARED DECISION-MAKING WITH WOMEN OF REPRODUCTIVE AGE AFFECTED BY CHRONIC INFLAMMATORY DISEASES

Abstract

Background:Previous research has indicated that women with a chronic inflammatory disease (CID) are likely to discontinue treatment during pregnancy. [1] Reasons for this are complex, including sub-optimal integration of shared decision-making (SDM) into practice.Objectives:The purpose of this study was to assess: 1) physicians’ competencies in risk assessment, treatment and management of women of reproductive age (WoRA) with a CID, and 2) clinical gaps, barriers and challenges to SDM with these patients.Methods:A mixed-methods needs assessment was conducted. [2] Participants included rheumatologists and dermatologists practicing in Germany, United Kingdom, or United States, with at least three years of experience. Exposure to patients diagnosed with rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis or psoriasis was required. A first phase involved collection and thematic analysis of data from semi-structured interviews to identify main challenge areas. The second phase consisted of online surveys to validate and quantify identified challenges, gaps and barriers. Chi-square and Kruskal Wallis H statistical tests were performed to assess differences by specialty, country and gender. Qualitative and quantitative findings were triangulated with insight from experts in medical education and relevant behavioural and clinical fields. [3] The present summary reports data pertaining to rheumatologists only.Results:A total of 24 interviews and 173 surveys were completed with rheumatologists. Depending on the country and specific item, 22% to 64% reported having sub-optimal knowledge of treatment options, patient education aids, and strategies to assess treatment adherence among WoRA with a CID (see figure 1). In addition, 36% reported having sub-optimal knowledge of methods to achieve SDM. Unplanned pregnancies were reported as a barrier to prescribing biologics to WoRA with a CID. Yet, 61% of rheumatologists reported having sub-optimal skills discussing contraceptive methods with patients. In addition, 41% reported having sub-optimal skills adjusting treatment according to changes in pregnancy status or child-bearing aspirations. Few differences in clinical gaps were observed by gender. Notably, a greater proportion of male rheumatologists reported having sub-optimal skills approaching WoRA in a way that makes them feel comfortable discussing their health concerns, compared to female rheumatologists (52% vs. 30%, p=0.046). This skill gap was identified as a contributing barrier to SDM with these patients.Conclusion:This study identified multiple challenges, gaps and barriers relevant to rheumatologists that prevent optimal SDM, risk assessment, treatment and management of WoRA with CID. Findings may be used to develop medical education and continuous professional development interventions for target learners.