Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
Department of Scholarship and Research, School of Nursing and College of Dental Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Pediatr Blood Cancer. 2022 Oct;69(10):e29877. doi: 10.1002/pbc.29877. Epub 2022 Jul 20.
Adolescent and young adult (AYA) women with sickle cell disease (SCD) have increased pregnancy-related health risks and are prescribed potentially teratogenic medications, yet limited data are available regarding pediatric SCD provider contraceptive practices. We aimed to assess pediatric hematology providers' beliefs, practices, motivators, and barriers for providing contraceptive care to female AYAs with SCD.
Guided by the Health Belief Model (HBM), we developed a 25-question, web-based survey to assess practices. Survey links were distributed nationwide to pediatric SCD and/or general hematology providers through their publicly available emails and by request to directors of U.S.-accredited Pediatric Hematology-Oncology fellowship programs for distribution to their SCD providers. Data analysis included descriptive statistics, chi-square analysis, and logistic regression.
Of 177 respondents, 160 surveys meeting inclusion criteria were analyzed. Most providers reported counseling (77.5%) and referring female AYA patients for contraception (90.8%), but fewer reported prescribing contraception (41.8%). Proportionally fewer trainees provided counseling compared with established providers (54% vs. 85%, p < .001), with a similar trend for prescribing (p = .05). Prescription practices did not differ significantly by provider beliefs regarding potential teratogenicity of hydroxyurea. Key motivators included patient request and disclosure of sexual activity. Key barriers included inadequate provider training, limited visit time, and perceived patient/parent interest.
Provider contraceptive practices for female AYAs with SCD varied, especially by provider status. Health beliefs regarding teratogenic potential of hydroxyurea did not correlate with contraceptive practices. Clinical guidelines, provider training, and patient/parent decision-making tools may be tested to assess whether provider contraceptive practices could be improved.
患有镰状细胞病（SCD）的青少年和年轻成年人（AYA）女性妊娠相关健康风险增加，并被开具潜在致畸药物，但关于儿科 SCD 提供者避孕实践的相关数据有限。我们旨在评估儿科血液学提供者为患有 SCD 的女性 AYA 提供避孕护理的信念、实践、动机和障碍。
我们根据健康信念模型（HBM）制定了一份 25 个问题的在线调查，以评估实践情况。通过公开提供的电子邮件向儿科 SCD 和/或一般血液学提供者分发调查链接，并请求美国认证的儿科血液学-肿瘤学奖学金计划主任将其分发给他们的 SCD 提供者。数据分析包括描述性统计、卡方分析和逻辑回归。
在 177 名受访者中，分析了符合纳入标准的 160 份调查。大多数提供者报告对女性 AYA 患者进行了避孕咨询（77.5%）和转介（90.8%），但报告避孕处方的比例较低（41.8%）。与资深提供者相比，培训生提供咨询的比例较低（54%与 85%，p<.001），开处方的趋势也相似（p=.05）。提供者对羟基脲潜在致畸性的信念并没有显著影响处方实践。主要动机包括患者的要求和性行为的披露。主要障碍包括提供者培训不足、就诊时间有限以及感知到患者/家长的兴趣。
为患有 SCD 的女性 AYA 提供避孕措施的提供者实践存在差异，特别是按提供者的身份。对羟基脲致畸潜力的健康信念与避孕实践无关。可以测试临床指南、提供者培训和患者/家长决策工具，以评估是否可以改善提供者的避孕实践。
