{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:58:42Z","timestamp":1781287122681,"version":"3.54.1"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["RA 3296\/1-1"],"award-info":[{"award-number":["RA 3296\/1-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Backgroud<\/jats:title>\n                    <jats:p>Uncertainty concerning motherhood is common among women with multiple sclerosis (wwMS). Therefore, we developed and pre-tested a patient decision aid (PtDA) and a nurse-led decision coaching intervention (DC) to support motherhood choice. The DC includes the PtDA, a decision guide on motherhood choice, and decision coaching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a randomised pilot trial across Germany to test feasibility, with decisional conflict (Decisional Conflict Scale, DCS) as an exploratory endpoint. Initially, we planned a 3:1 randomisation ratio (planned; PtDA\u2009=\u200948, DC\u2009=\u200916). Due to recruitment difficulties, we switched to a 1:1 randomisation ratio to ensure an appropriate sample size (PtDA\u2009&gt;\u200920, DC\u2009&gt;\u200910). Women between 18 and 45 years old with relapsing-remitting MS or clinically isolated syndrome, and who had not yet decided about motherhood, were eligible. We recruited two nurses for our decision coaching training course. We used questionnaires to measure decisional conflict, programme feasibility, knowledge, and worries regarding pregnancy in MS. Interviews were conducted to gain in-depth information on the potential feasibility of the programmes. Interviews were analysed thematically and questionnaires descriptively. We conducted explorative group comparisons and merged findings using joint display analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We trained two decision coaches in the DC group and recruited 35 wwMS (PtDA\u2009=\u200922; DC\u2009=\u200913) over five months. Median DCS scores in the DC group were 49 at baseline and 15 at follow-up (range 0\u2013100; higher scores indicate greater decisional conflict). In the PtDA group, scores were 54 (baseline) and 31 (follow-up). Explorative group comparison indicated lower decisional conflict at follow-up in the DC group than in the PtDA group (p\u2009=\u20090.035). Interviewees (PtDA\u2009=\u20095; DC\u2009=\u20096; nurses\u2009=\u20092) described both interventions as helpful for decision-making. Qualitative findings indicate greater satisfaction levels in the DC group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both interventions appear useful for wwMS in making motherhood choices. The DC programme seems more promising in supporting decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>German Clinical Trials Register (DRKS); DRKS00038534.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351108","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:35:17Z","timestamp":1781285717000},"page":"e0351108","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Motherhood choice in multiple sclerosis (MoMS) \u2013 Pilot trial of web-based decision support"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6591-533X","authenticated-orcid":true,"given":"Lara S.","family":"Stahl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Hickstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"K\u00f6pke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Hellwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Heesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne C.","family":"Rahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"pone.0351108.ref001","first-page":"1","article-title":"Epidemiologie der Multiplen Sklerose \u2013 Eine populationsbasierte deutschlandweite Studie","volume":"17","author":"J Holstiege","year":"2017","journal-title":"Zentralinstitut F\u00fcr Kassen\u00e4rztliche Versorg Dtschl"},{"key":"pone.0351108.ref002","unstructured":"Multiple Sclerosis International Federation. Atlas of MS - 3rd Edition [Internet]. 2020 [cited 2023 Jul 11]. Available from: https:\/\/atlasofms.org"},{"key":"pone.0351108.ref003","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.msard.2019.04.003","article-title":"Management strategies for female patients of reproductive potential with multiple sclerosis: an evidence-based review","volume":"32","author":"PK Coyle","year":"2019","journal-title":"Mult Scler Relat Disord"},{"issue":"5","key":"pone.0351108.ref004","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1038\/nrneurol.2015.53","article-title":"Multiple sclerosis and pregnancy in the \u201ctreatment era\u201d","volume":"11","author":"S Vukusic","year":"2015","journal-title":"Nat Rev Neurol"},{"issue":"5","key":"pone.0351108.ref005","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1177\/1352458507086103","article-title":"The motherhood choice: themes arising in the decision-making process for women with multiple sclerosis","volume":"14","author":"M Prunty","year":"2008","journal-title":"Mult Scler"},{"issue":"8","key":"pone.0351108.ref006","doi-asserted-by":"crossref","first-page":"629","DOI":"10.3109\/09638280903204708","article-title":"Becoming mothers. Multiple sclerosis and motherhood: a qualitative study","volume":"32","author":"D Payne","year":"2010","journal-title":"Disabil Rehabil"},{"issue":"6","key":"pone.0351108.ref007","first-page":"28","article-title":"Multiple sclerosis: pregnancy and motherhood","volume":"16","author":"J Anderson","year":"2013","journal-title":"Pract Midwife"},{"issue":"10","key":"pone.0351108.ref008","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.pec.2015.06.022","article-title":"Shared decision making: concepts, evidence, and practice","volume":"98","author":"AM Stiggelbout","year":"2015","journal-title":"Patient Educ Couns"},{"issue":"1","key":"pone.0351108.ref009","article-title":"Decision aids for people facing health treatment or screening decisions","volume":"1","author":"D Stacey","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0351108.ref010","unstructured":"L\u00fchnen J, Albrecht M, M\u00fchlhauser I, Steckelberg A. Leitlinie evidenzbasierte Gesundheitsinformation [Internet]. 2017 [cited 2023 Jul 11]. Available from: http:\/\/www.leitlinie-gesundheitsinformation.de\/"},{"issue":"1","key":"pone.0351108.ref011","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.pec.2007.10.021","article-title":"The motherhood choice: a decision aid for women with multiple sclerosis","volume":"71","author":"MC Prunty","year":"2008","journal-title":"Patient Educ Couns"},{"issue":"7","key":"pone.0351108.ref012","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1177\/0272989X21997330","article-title":"Guidance and\/or decision coaching with patient decision aids: scoping reviews to inform the International Patient Decision Aid Standards (IPDAS)","volume":"41","author":"AC Rahn","year":"2021","journal-title":"Med Decis Making"},{"key":"pone.0351108.ref013","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijnurstu.2017.08.011","article-title":"Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) - Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation","volume":"78","author":"AC Rahn","year":"2018","journal-title":"Int J Nurs Stud"},{"key":"pone.0351108.ref014","unstructured":"Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. Plan Baby bei MS [Internet]. [cited 2025 Jan 11]. Available from: https:\/\/plan-baby-bei-ms.dmsg.de\/plan-baby-bei-ms\/"},{"key":"pone.0351108.ref015","first-page":"1","article-title":"Best practices for mixed methods research in the health sciences","volume":"29","author":"H Meissner","year":"2011","journal-title":"Methods"},{"key":"pone.0351108.ref016","article-title":"Developing and evaluating complex interventions: the new Medical Research Council guidance","volume":"337","author":"P Craig","year":"2008","journal-title":"BMJ"},{"key":"pone.0351108.ref017","article-title":"A systematic development process for patient decision aids","author":"A Coulter","year":"2013","journal-title":"BMC Med Inform Decis Mak"},{"key":"pone.0351108.ref018","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"TC Hoffmann","year":"2014","journal-title":"BMJ"},{"issue":"2","key":"pone.0351108.ref019","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1046\/j.1365-2753.2001.00286.x","article-title":"Shared decision making observed in clinical practice: visual displays of communication sequence and patterns","volume":"7","author":"G Elwyn","year":"2001","journal-title":"J Eval Clin Pract"},{"issue":"3","key":"pone.0351108.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0150205","article-title":"Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework","volume":"11","author":"SM Eldridge","year":"2016","journal-title":"PLoS One"},{"key":"pone.0351108.ref021","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"GF Moore","year":"2015","journal-title":"BMJ"},{"key":"pone.0351108.ref022","article-title":"CONSORT 2010 statement: extension to randomised pilot and feasibility trials","volume":"2016","author":"SM Eldridge","year":"2016","journal-title":"BMJ"},{"key":"pone.0351108.ref023","unstructured":"Ottawa Hospital Research Institute. Ottawa Decision Support Tutorial. [Internet]. 2022 [cited 2024 Jun 21]. Available from: https:\/\/decisionaid.ohri.ca\/ODST\/"},{"issue":"3","key":"pone.0351108.ref024","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.jclinepi.2011.07.011","article-title":"The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency","volume":"65","author":"J Sim","year":"2012","journal-title":"J Clin Epidemiol"},{"key":"pone.0351108.ref025","unstructured":"Sealed Envelope Ltd. Create a blocked randomisation list. [Online] [Internet]. 2022. [cited 2022 Sep 29]. Available from: https:\/\/www.sealedenvelope.com\/simple-randomiser\/v1\/lists"},{"key":"pone.0351108.ref026","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1471-2377-13-37","article-title":"Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis","volume":"13","author":"YC Learmonth","year":"2013","journal-title":"BMC Neurol"},{"issue":"3","key":"pone.0351108.ref027","first-page":"21","article-title":"The Control Preferences Scale","volume":"29","author":"LF Degner","year":"1997","journal-title":"Can J Nurs Res Rev Can Rech En Sci Infirm"},{"key":"pone.0351108.ref028","unstructured":"O\u2019Connor A. User Manual - Decisional Conflict Scale (16 item statement format) [document on the Internet]. [Internet]. 1993 [cited 2024 May 24]. Available from: http:\/\/decisionaid.ohri.ca\/docs\/develop\/U"},{"key":"pone.0351108.ref029","first-page":"15","article-title":"Die Decisional Conflict Scale in deutscher Sprache (DCS-D) \u2013 Dimensionale Struktur in einer Stichprobe von Hausarztpatienten","volume":"4","author":"A Buchholz","year":"2011","journal-title":"Klin Diagn Eval"},{"key":"pone.0351108.ref030","doi-asserted-by":"crossref","first-page":"103831","DOI":"10.1016\/j.msard.2022.103831","article-title":"Motherhood choice in multiple sclerosis (MoMS) development and piloting of patient-reported outcome measures","volume":"63","author":"L Steinberg","year":"2022","journal-title":"Mult Scler Relat Disord"},{"key":"pone.0351108.ref031","doi-asserted-by":"crossref","first-page":"104789","DOI":"10.1016\/j.msard.2023.104789","article-title":"Knowledge and worries on motherhood choice in multiple sclerosis - a cross-sectional study on patient-reported outcome measures","volume":"76","author":"J Peper","year":"2023","journal-title":"Mult Scler Relat Disord"},{"issue":"4","key":"pone.0351108.ref032","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.zefq.2012.04.005","article-title":"Completing the third person\u2019s perspective on patients\u2019 involvement in medical decision-making: approaching the full picture","volume":"106","author":"J Kasper","year":"2012","journal-title":"Z Evid Fortbild Qual Gesundhwes"},{"issue":"7","key":"pone.0351108.ref033","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1177\/0272989X211014163","article-title":"Systematic development of patient decision aids: an update from the IPDAS collaboration","volume":"41","author":"HO Witteman","year":"2021","journal-title":"Med Decis Making"},{"key":"pone.0351108.ref034","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988","edition":"2"},{"key":"pone.0351108.ref035","volume-title":"IBM SPSS Statistics, Version 27.0","author":"IBM Corp","year":"2020"},{"key":"pone.0351108.ref036","doi-asserted-by":"crossref","unstructured":"Brooks J, King N. Doing Template Analysis: Evaluating an End-of-Life Care Service [Internet]. 2014. https:\/\/doi.org\/10.4135\/978144627305013512755","DOI":"10.4135\/978144627305013512755"},{"key":"pone.0351108.ref037","unstructured":"King N. Template Analysis (Online) [Internet]. [cited 2022 Oct 5]. Available from: https:\/\/research.hud.ac.uk\/research-subjects\/human-health\/template-analysis\/"},{"key":"pone.0351108.ref038","unstructured":"VERBI Software. MAXQDA 2020 [Internet]. VERBI Software 2019, Berlin. 2020 [cited 2023 Jul 11]. Available from: https:\/\/www.maxqda.com"},{"key":"pone.0351108.ref039","article-title":"Using Joint display as an analytic process: an illustration using bar graphs joint displays from a mixed methods study of how beliefs shape secondary school teachers\u2019 use of technology","volume":"20","author":"TK Haynes-Brown","year":"2021","journal-title":"Int J Qual Methods"},{"key":"pone.0351108.ref040","first-page":"520","volume-title":"Designing and Conducting Mixed Methods Research","author":"JW Creswell","year":"2017"},{"key":"pone.0351108.ref041","unstructured":"Microsoft Corporation. Microsoft Excel [Internet]. 2022 [cited 2022 Jun 23]. Available from: https:\/\/www.microsoft.com\/de-de\/microsoft-365\/excel?market=de"},{"key":"pone.0351108.ref042","unstructured":"Canva Pro [Internet]. [cited 2025 Aug 30]. Available from: https:\/\/www.canva.com"},{"key":"pone.0351108.ref043","unstructured":"Good Clinical Practice Network. Good Clinical Practice. 2022. [cited 2025 Oct 5]. Available from: https:\/\/ichgcp.net\/"},{"issue":"1","key":"pone.0351108.ref044","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/0272989X9501500105","article-title":"Validation of a decisional conflict scale","volume":"15","author":"AM O\u2019Connor","year":"1995","journal-title":"Med Decis Making"},{"issue":"1","key":"pone.0351108.ref045","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12884-022-04402-x","article-title":"The effectiveness of decision aids for pregnancy related decision-making in women with pre-pregnancy morbidity; systematic review and meta-analysis","volume":"22","author":"R Whybrow","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"pone.0351108.ref046","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1177\/0272989X17697304","article-title":"Evaluation of a decision aid for women with epilepsy who are considering pregnancy: a randomized controlled trial","volume":"37","author":"A McGrath","year":"2017","journal-title":"Med Decis Making"},{"key":"pone.0351108.ref047","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1186\/s12891-015-0713-0","article-title":"The motherhood choices decision aid for women with rheumatoid arthritis increases knowledge and reduces decisional conflict: a randomized controlled trial","volume":"16","author":"T Meade","year":"2015","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"pone.0351108.ref048","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s13063-016-1233-4","article-title":"A patient decision aid for antidepressant use in pregnancy: study protocol for a randomized controlled trial","volume":"17","author":"S Vigod","year":"2016","journal-title":"Trials"},{"issue":"4","key":"pone.0351108.ref049","doi-asserted-by":"crossref","DOI":"10.3399\/bjgpopen19X101666","article-title":"Patient decision aids for antidepressant use in pregnancy: a pilot randomised controlled trial in the UK","volume":"3","author":"H Khalifeh","year":"2019","journal-title":"BJGP Open"},{"issue":"11","key":"pone.0351108.ref050","article-title":"Decision coaching for people making healthcare decisions","volume":"11","author":"J Jull","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0351108.ref051","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12911-022-01870-1","article-title":"The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy","volume":"22","author":"N Hussain-Shamsy","year":"2022","journal-title":"BMC Med Inform Decis Mak"},{"issue":"1","key":"pone.0351108.ref052","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1186\/s12911-022-02007-0","article-title":"Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review","volume":"22","author":"J Zhao","year":"2022","journal-title":"BMC Med Inform Decis Mak"},{"issue":"3","key":"pone.0351108.ref053","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.pec.2013.10.031","article-title":"Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making","volume":"94","author":"N Joseph-Williams","year":"2014","journal-title":"Patient Educ Couns"},{"key":"pone.0351108.ref054","doi-asserted-by":"crossref","first-page":"107673","DOI":"10.1016\/j.pec.2023.107673","article-title":"Family planning and multiple sclerosis: a qualitative study of patient experiences to understand information needs and promote informed decision-making","volume":"110","author":"A Fragkoudi","year":"2023","journal-title":"Patient Educ Couns"},{"key":"pone.0351108.ref055","doi-asserted-by":"crossref","first-page":"620772","DOI":"10.3389\/fneur.2021.620772","article-title":"Family planning decision making in people with multiple sclerosis","volume":"12","author":"S Bonavita","year":"2021","journal-title":"Front Neurol"},{"key":"pone.0351108.ref056","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.msard.2018.06.006","article-title":"Patient awareness about family planning represents a major knowledge gap in multiple sclerosis","volume":"24","author":"PV Rasmussen","year":"2018","journal-title":"Mult Scler Relat Disord"},{"issue":"4","key":"pone.0351108.ref057","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s00115-024-01621-9","article-title":"Schwangerschaft und Stillzeit bei Frauen mit Multipler Sklerose","volume":"95","author":"L Witt","year":"2024","journal-title":"Nervenarzt"},{"key":"pone.0351108.ref058","unstructured":"Hemmer B, et al. Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis-optica-Spektrum- Erkrankungen und MOG-IgG-assoziierten Erkrankungen, S2k-Leitlinie. In: Deutsche Gesellschaft f\u00fcr Neurologie(Hrsg.), Leitlinien f\u00fcr Diagnostik und Therapie in der Neurologie. 2021. www.dgn.org\/leitlinien"},{"key":"pone.0351108.ref059","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ijnurstu.2019.01.013","article-title":"Nurse-led coaching of shared decision-making for women with ductal carcinoma in situ in breast care centers: a cluster randomized controlled trial","volume":"93","author":"B Berger-H\u00f6ger","year":"2019","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"pone.0351108.ref060","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1186\/s12884-022-04498-1","article-title":"Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis","volume":"22","author":"K Hammarberg","year":"2022","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:35:35Z","timestamp":1781285735000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351108"}},"subtitle":[],"editor":[{"given":"Pasyodun Koralage Buddhika","family":"Mahesh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":60,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351108","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}