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Objective: Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. Data Sources and Study Setting: Quantitative surveys and qualitative interviews were collected from participants living in the community. Study Design: Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). Data Collection: Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. Principal Findings: Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial n. (2) [90% CI] = 0.310 [0.08,0.46], 0.435 [0.19, 0.60], 0.134 [0,0.29], 0.178 [0.01,0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). Conclusions: The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care. KEYWORDS decision making, feasibility studies, health disparities, physical disability, pregnancy, women's health What is known on this topic * Women with physical disabilities are no different than their non-disabled peers in their desire to have children, but are almost twice as likely to be uncertain if they will be able to. * Many women with physical disabilities experience bias and discrimination in health care settings when seeking counsel about pregnancy. * Despite evidence that the pregnancy decision making process is suboptimal, there are few, if any, solutions to support women with physical disabilities in deciding whether to pursue a future pregnancy. What this study adds * A pregnancy decision making tool designed for women with physical disabilities shows promise for supporting certainty and decisional readiness. * Results suggest that using a decision making tool helps to organize thinking and planning by prompting questions to discuss with health care providers. * Feedback from participants highlight the opportunities for expanding content and the limitations of a paper-based format., 1 | INTRODUCTION Uncertainty characterizes the pregnancy decision making process of women with physical disabilities, (1) defined by limitations in physical function, mobility, dexterity, or stamina. While they are no [...]

Supported self‐management interventions for individuals with systemic sclerosis (SSc) are needed. We examined the effects of a 12‐week resilience‐building energy management program (called RENEW) for fatigue and other patient‐reported outcomes. Participants, who had physician‐diagnosed SSc, moderate to severe fatigue, and were ≥18 years old, were randomly assigned to RENEW or waitlist control in a 2:1 ratio. The RENEW intervention included an educational website/application plus nine virtual peer‐led health coaching sessions. The primary outcome was change in the Functional Assessment of Chronic Illness Therapy‐Fatigue scale. Secondary outcomes were change in Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms and Connor‐Davidson Resilience Scale. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. Multiple imputation was conducted; linear mixed models were used to assess group differences. A three‐way interaction with group, time, and SSc duration was examined in each model. Among 173 participants (mean ± SD age 54.5 ± 11.7 years; 93% female, 85% White), 47% had diffuse cutaneous SSc; 57% were ≤5 years from diagnosis. At 12 weeks, compared to controls, RENEW participants had a clinically meaningful fatigue improvement (β = −4.7; 95% confidence interval −6.7 to −2.7; P< 0.001) and improvement in all secondary outcomes. Among RENEW participants, individuals with shorter disease duration had greater improvements in fatigue at 12 weeks. An mHealth supported self‐management intervention improved fatigue and other outcomes, particularly in newly diagnosed patients. This program may be broadly scalable for SSc symptom management.