Impact of a Multifaceted Educational Program to Improve Provider Skills for Lupus Pregnancy Planning and Management: A Mixed-Methods Approach.

Abstract

OBJECTIVE:To bring recent advances in pregnancy management in lupus to women nationwide, this multidimensional educational intervention sought to equip community rheumatologists with the needed skills, attitudes, and confidence to manage contraceptive decisions and pregnancy planning for women with lupus. METHODS:The program included an in-person didactic, training in use of a comprehensive handout to guide contraception and pregnancy conversations, a simulated clinical experience, and access to an innovative website (www.lupuspregnancy.org). The program was analyzed using mixed methods, which included a quantitative survey by e-mail before and after program completion and multiple qualitative interviews about attendees' experiences integrating created resources into practice. RESULTS:The analysis included 68 preintervention surveys and 55 postintervention surveys. For qualitative analysis, eight interviews were completed until thematic saturation was achieved. After completion of the program, there was an increase in providers reporting a systematic approach to preparing a woman with lupus for pregnancy (from 45.6% to 94.6%; P < 0.0001). Confidence in choosing both appropriate contraception and pregnancy-compatible medications improved significantly. As expected, change in knowledge about contraception was limited. Qualitative themes included the utility of the printable handouts, enthusiasm for the program, increased confidence and, importantly, increased empathy for the patients. CONCLUSION:We created a valuable implementation tool that improves self-reported provider skills and confidence in managing women with lupus who desire pregnancy. Providers now have access to a unique curriculum and resources that encourage providers to have open and accurate conversations about pregnancy, thus creating lasting clinical change.