Patient Decision Aid (PDA) for Antidepressant Use In Pregnancy: a Pilot RCT

Brief Summary

Detailed Description

Depression in pregnancy is common, affecting up to 10% of women and represents serious risk to mother and infant. Unfortunately, antidepressant medication, a first-line treatment for depression in pregnancy, also comes with risks, making this a complex decision. Clinical care appears to be insufficient for ensuring that women make decisions that are consistent with their own values and with which they feel satisfied. Patient decision support tools can address such barriers. Canadian colleagues have created a patient decision aid (PDA) that has the potential to improve the decision-making process for women regarding antidepressant use in pregnancy in conjunction with clinical care. This study is a pilot RCT of the above PDA in London, to be conducted in parallel with a pilot RCT in Toronto.The overall objective of this project is to inform the development of a larger, international RCT to assess the efficacy of this PDA for antidepressant use in pregnancy. To achieve this objective, the investigators will assess the feasibility of the trial protocol to evaluate the PDA and determine the preliminary effect size for a larger multisite efficacy study. The primary outcome for this pilot study is the feasibility of conducting a large randomized controlled trial to evaluate the efficacy of the PDA. This includes feasibility (how well the trial protocol can be implemented), acceptability (usability and tolerability of the intervention) and adherence (the degree to which the trial protocol is followed). It is hypothesized that the protocol will be feasible, that the PDA will have a high degree of acceptability, and that adherence to the protocol will be high.

Primary Outcomes

Secondary Outcomes

• Treatment Decision(s)((a) Baseline (pre-randomization) and (b) 4 Weeks post-randomization and (c) 12 weeks postpartum (for participants who enrolled while pregnant) OR 6 months post-randomization (for women who enrolled while planning a pregnancy))
• Depression, measured by the Edinburgh Postnatal Depression Scale((a) Baseline (pre-randomization) and (b) 4 Weeks post-randomization and (c) 12 weeks postpartum (for participants who enrolled while pregnant) OR 6 months post-randomization (for women who enrolled while planning a pregnancy))
• Decisional conflict, measured by the Decisional Conflict Scale(Baseline (pre-randomization) and 4 Weeks post-randomization)
• Intervention acceptability to patients, measured by the PDA Acceptability Questionnaire(4 Weeks post-randomization])
• Intervention acceptability to clinicians, measured by the Provider Perspective Survey(After follow-up data is complete (12 weeks postpartum if last patient was recruited in pregnancy, or 6 months after baseline interview if last patient was recruited when planning a pregnancy))
• Anxiety, measured by the Spielburg State-Trait Anxiety Inventory((a) Baseline (pre-randomization) and (b) 4 Weeks post-randomization and (c) 12 weeks postpartum (for participants who enrolled while pregnant) OR 6 months post-randomization (for women who enrolled while planning a pregnancy))
• Knowledge about antidepressant treatment in pregnancy(Baseline (pre-randomization) and 4 Weeks post-randomization)
• Feasibility, measured by 'Study Website Usage'(4 Weeks post-randomization)
• Feasibility, measured by 'Number of participants who follow-up with their physician during the intended timeline'(4 weeks post-randomization)
• Feasibility, measured by 'The rate of follow-up data collection'((a) 4 Weeks post-randomization and (b) 12 weeks postpartum (for participants who enrolled while pregnant) OR 6 months post-randomization (for women who enrolled while planning a pregnancy))
• Feasibility, measure by 'Time between recruitment to first log-in to the study website'(4 weeks post-randomization)