Amico Jennifer R, Bennett Ariana H, Karasz Alison, Gold Marji
Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Contraception. 2017 Aug;96(2):106-110. doi: 10.1016/j.contraception.2017.05.007. Epub 2017 May 31.
This study describes the perceptions and experiences of family physicians when women request early intrauterine device (IUD) removal.
This qualitative study included semistructured individual interviews with 12 physicians who encountered patients seeking early IUD removal. We identified eligible participants via chart review. We analyzed interviews using deductive and inductive techniques to identify content and themes.
Physicians consistently referred to IUDs as the "best" or their "favorite" method, and several joked that they tried to "sell" the IUD during contraceptive counseling. Most reported having mixed or negative feelings when patients opted to remove the IUD. Most encouraged their patients to continue the IUD, hoping to delay removal until symptoms resolved so that removal was not needed. Some physicians reported feeling guilty or as if they had "failed" when a patient wanted the IUD removed. Many providers reported a conflict between valuing patient autonomy and feeling that early removal was not in the patient's best interest.
Physicians have complex and contradictory feelings about early IUD removal. While most providers acknowledged the need for patient autonomy, they still reported encouraging IUD continuation based on their own opinion about the IUD.
While IUDs are highly effective and well-liked contraceptives, providers' responses to IUD removal requests have implications for both reproductive autonomy as well as the doctor-patient relationship. More work is needed to ensure that providers remove a patient's IUD when requested.
本研究描述了女性要求提前取出宫内节育器（IUD）时家庭医生的看法和经历。
这项定性研究包括对12名遇到要求提前取出IUD患者的医生进行半结构化个人访谈。我们通过病历审查确定符合条件的参与者。我们使用演绎和归纳技术分析访谈内容以确定主题。
医生们一直将IUD称为“最佳”或他们“最喜欢”的方法，有几位开玩笑说他们在避孕咨询时试图“推销”IUD。大多数医生表示，当患者选择取出IUD时，他们会有复杂或消极的情绪。大多数医生鼓励患者继续使用IUD，希望推迟取出直到症状缓解从而无需取出。一些医生表示，当患者想要取出IUD时，他们会感到内疚或好像自己“失败了”。许多医疗服务提供者表示，在重视患者自主权与认为提前取出不符合患者最佳利益之间存在冲突。
医生对提前取出IUD有着复杂且矛盾的感受。虽然大多数医疗服务提供者承认需要尊重患者自主权，但他们仍表示会基于自己对IUD的看法鼓励患者继续使用。
虽然IUD是高效且受欢迎的避孕方法，但医疗服务提供者对取出IUD请求的反应对生殖自主权以及医患关系都有影响。需要开展更多工作以确保医疗服务提供者在患者要求时取出其IUD。
