Abstract
ObjectiveTo examine how female patients with RA form decisions about having children, pregnancy, and medication use.MethodsWe employed a constructivist grounded theory design and recruited female participants who are 18 years or older, have a rheumatologist-confirmed RA diagnosis, live in Canada, and are able to communicate in English or French. We collected data through semi-structured individual and focus group interviews using telephone or video conferencing technology. Data collection and analysis were iterative, employed theoretical sampling, reflexive journaling, and peer debriefing, and culminated in a theoretical model.ResultsWe recruited 21 participants with a mean age of 34 years and median 10 years since RA diagnosis. Overall, 33% had never been pregnant, 57% had previously been pregnant, and 10% were pregnant at the time of interview. Of those who had experienced pregnancy, 64% had at least one pregnancy while diagnosed with RA and of those, 56% used DMARD(s) during a pregnancy. We constructed a patient-centred framework depicting the dynamic relationships between 4 decision-making processes—(1) using medications, (2) having children, (3) planning pregnancy, and (4) parenting—and the substantial impact of healthcare providers on patients’ experiences making these decisions. These processes were further influenced by participants’ intersecting identities and contextual factors, particularly attitudes towards health and medications, disease onset and severity, familial support system, and experiences interacting with the healthcare system.ConclusionOur framework provides insight into how patients make reproductive decisions in the context of managing RA and the opportunities for providers to support them at each decision-making process. A patient-centred care approach is suggested to support female patients with RA in making reproductive and medication choices aligning with their individual desires, needs, and values.
Highlights
IntroductionRecent evidence suggests a decrease in rheumatoid arthritis (RA) activity in 60% of pregnant patients [1, 2] with only 20–40% attaining remission by the third trimester of pregnancy [3, 4]
Managing rheumatoid arthritis (RA) during pregnancy is a therapeutic challenge
Female patients with RA have information needs about medications in pregnancy [10,11,12,13], despite recent evidence-based guidelines supporting the safety of some disease-modifying anti-rheumatic drugs (DMARDs) in pregnancy [14,15,16,17]
Summary
Recent evidence suggests a decrease in RA activity in 60% of pregnant patients [1, 2] with only 20–40% attaining remission by the third trimester of pregnancy [3, 4]. Female patients with RA have information needs about medications in pregnancy [10,11,12,13], despite recent evidence-based guidelines supporting the safety of some disease-modifying anti-rheumatic drugs (DMARDs) in pregnancy [14,15,16,17]. Despite recognition that females with RA are not meeting their reproductive goals, there are no studies examining the process of reproductive decisionmaking; the trade-offs related to managing disease activity and potential pregnancy. We aimed to develop a constructivist grounded theory of patients’ reproductive decision-making within the context of living with RA
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