title: Establishing cross-discipline consensus on contraception, pregnancy and breast feeding-related educational messages and clinical practices to support women with rheumatoid arthritis: an Australian Delphi study.
abstract: Recognising the need for a best-practice and consistent approach in providing care to women with rheumatoid arthritis (RA) in relation to (1) general health, (2) contraception, (3) conception and pregnancy, (4) breast feeding and (5) early parenting, we sought to achieve cross-discipline, clinical consensus on key messages and clinical practice behaviours in these 5 areas.
  
  
  
  3-round eDelphi study. In round 1, panellists provided free-text responses to open-ended questions about care for women with RA across the 5 areas. Subsequently, panellists refined and scored the synthesised responses, presented as metathemes, themes and detailed elements. Where ≥5% of panellists did not support a theme in a given round, it was removed.
  
  
  
  Panel of practicing Australian rheumatologists (n=22), obstetricians/obstetric medicine physicians (n=9) and pharmacists (n=5).
  
  
  
  34 (94.4%) panellists participated in all 3 rounds. The panel supported 18 themes across the 5 areas (support/strongly support: 88.2-100%) underpinned by 5 metathemes. Metathemes focused on coordination in information delivery, the mode and timing of information delivery, evidence underpinning information, engagement of the right health professionals at the right time and a non-judgemental approach to infant feeding. Themes included practices for primary prevention of chronic disease and their sequelae, the importance of contraception and planning pregnancy and breast feeding, close monitoring of medications, supporting mental well-being, managing disease activity and providing practical support for early parenting.
  
  
  
  A cross-disciplinary clinical panel highly supported key information and clinical practices in the care for women with RA across the continuum of contraception to early parenting within a whole-person, chronic disease management approach.
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia Move: Muscle, Bone and Joint Health, Melbourne, Victoria, Australia.
authors.forename: Andrew M
authors.identifier: 0000-0002-6736-3098
authors.initials: AM
authors.lastname: Briggs
authors.affiliation: HealthSense (Aust) Pty Ltd, Melbourne, Victoria, Australia.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Jordan
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Department of Medicine, Melbourne EpiCentre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Ilana N
authors.initials: IN
authors.lastname: Ackerman
authors.affiliation: Department of Medicine, Melbourne EpiCentre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia Department of Rheumatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Van Doornum
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D001315:Australia; D001942:Breast Feeding; D032921:Consensus; D003267:Contraception; D003697:Delphi Technique; D005260:Female; D005306:Fertilization; D006801:Humans; D010353:Patient Education as Topic; D010595:Pharmacists; D010820:Physicians; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy
chemical_list: D018501:Antirheumatic Agents
keywords: MEDICAL EDUCATION & TRAINING