Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC
Division of Family Planning (Dineley, Fitzsimmons, Renner), Departments of Obstetrics and Gynaecology (Munro) and Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK; Department of General Surgery (Zevin), Queen's University, Kingston, Ont.; Department of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of General Surgery (Katiraee), University of British Columbia, Vancouver, BC.
CMAJ Open. 2022 Mar 22;10(1):E255-E261. doi: 10.9778/cmajo.20200304. Print 2022 Jan-Mar.
Evidence suggests an increase in fertility and unintended pregnancy after bariatric surgery; contraceptive counselling, traditionally defined as a discussion of contraception options, is therefore an important facet of surgical planning. Our aim was to investigate patient experiences of contraceptive counselling, the attitudes of health care providers (HCPs) toward contraceptive counselling, and their perceptions of the facilitators and barriers to contraceptive counselling in bariatric surgery clinics.
We conducted a qualitative study using semistructured interviews with patients and HCPs at publicly funded Canadian bariatric surgery clinics from May 2018 to February 2019. We recruited bariatric HCPs from across Canada using snowball sampling, and recruited patient participants from 3 Canadian bariatric surgery programs. Patient participants had to be at risk of pregnancy in the postoperative period, aged 18-45 years old and have completed all preoperative counselling. We included HCPs who delivered care in a publicly funded, hospital-affiliated bariatric surgery clinic in Canada. Team members analyzed transcripts thematically.
We completed 27 interviews (patient = 16, HCP = 11). Our analysis identified 3 separate themes: missing information in contraception counselling, making assumptions about who would benefit from counselling and strategies for improving contraception counselling. We found patients and HCPs wanted more resources on the safety and efficacy of contraceptive methods.
Our study showed a need for structured contraceptive counselling in bariatric surgery clinics. Information resources that support patients and HCPs who provide counselling are needed.
有证据表明，减重手术后生育能力和意外怀孕的情况有所增加；因此，避孕咨询（传统上定义为讨论避孕选择）是手术计划的一个重要方面。我们的目的是调查患者对避孕咨询的体验、医疗保健提供者（HCP）对避孕咨询的态度，以及他们对肥胖手术诊所中避孕咨询的促进因素和障碍的看法。
我们使用半结构式访谈，于 2018 年 5 月至 2019 年 2 月在加拿大有公共资金支持的肥胖手术诊所对患者和 HCP 进行了定性研究。我们使用滚雪球抽样从加拿大各地招募肥胖症 HCP，并从 3 个加拿大肥胖症手术计划中招募患者参与者。患者参与者必须在术后有怀孕风险，年龄在 18-45 岁之间，并且已经完成了所有术前咨询。我们纳入了在加拿大公立医院附属肥胖手术诊所提供护理的 HCP。团队成员对转录本进行了主题分析。
我们完成了 27 次访谈（患者=16，HCP=11）。我们的分析确定了 3 个独立的主题：避孕咨询中信息缺失、对谁将受益于咨询做出假设以及改善避孕咨询的策略。我们发现患者和 HCP 希望获得更多关于避孕方法安全性和有效性的资源。
我们的研究表明肥胖手术诊所需要进行有结构的避孕咨询。需要支持为患者和提供咨询的 HCP 提供信息资源。
