Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, L3, 207 Bouverie Street, Parkville, Vic. 3010, Australia; and Corresponding author. Email:
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, L3, 207 Bouverie Street, Parkville, Vic. 3010, Australia; and Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.
Aust J Prim Health. 2021 Dec;27(6):467-472. doi: 10.1071/PY21054.
Long-acting reversible contraceptives (LARC) are the most effective contraceptive methods available in Australia and are effective for between 3 and 8 years. Early LARC removal (<12 months of use) can lead to gaps in contraceptive cover, exposing women to the risk of unplanned pregnancy. This study explored the experiences of doctors working in primary care (GPs and sexual health physicians) when asked to remove LARC earlier than expected. From May to July 2020, 13 doctors in Melbourne, Australia, were interviewed. Overall, participants felt conflicted about early LARC removal requests; participants highlighted the importance of respecting patient autonomy, but many felt that patients should ideally persist with LARC longer. Participants found balancing a desire to respect patients' autonomy with their clinical responsibility challenging. Doctors used reassurance, delaying tactics and treatment of side effects to try and prolong LARC use. However, this balancing act led many doctors to perceive a tension between themselves and their patients when early LARC removal was requested. Incorporating professional education addressing these issues may help primary care providers better anticipate and navigate the tension surrounding early LARC removal consultations and maintain effective doctor-patient relationships.
长效可逆避孕措施（LARC）是澳大利亚可用的最有效的避孕方法，有效时间为 3 至 8 年。早期 LARC 取出（使用不足 12 个月）可能导致避孕措施出现空白，使妇女面临意外怀孕的风险。本研究探讨了在被要求提前取出 LARC 时，在初级保健（全科医生和性健康医生）工作的医生的经验。2020 年 5 月至 7 月，澳大利亚墨尔本的 13 名医生接受了采访。总体而言，参与者对提前取出 LARC 的请求感到矛盾；参与者强调了尊重患者自主权的重要性，但许多人认为患者理想情况下应坚持使用 LARC 更长时间。参与者发现，平衡尊重患者自主权的愿望与他们的临床责任具有挑战性。医生使用保证、拖延策略和治疗副作用来试图延长 LARC 的使用时间。然而，这种平衡行为使许多医生在要求提前取出 LARC 时，感到自己和患者之间存在紧张关系。纳入解决这些问题的专业教育可能有助于初级保健提供者更好地预测和应对围绕早期 LARC 取出咨询的紧张局势，并维持有效的医患关系。
