Thornton Madeline, Bullington Brooke W, Berg Kristen A, White Kari, Larkin Suzanna, Boozer Margaret, Serna Tania, Miller Emily S, Bailit Jennifer L, Arora Kavita S
University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, NC, USA.
University of North Carolina, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA.
Contraception. 2025 Mar;143:110781. doi: 10.1016/j.contraception.2024.110781. Epub 2024 Dec 4.
OBJECTIVE(S): We sought to understand patients' and obstetrician-gynecologists' priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient's initial contraceptive preference.
We interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (n = 67) from four US institutions to explore patient and obstetrician-gynecologist (OBGYN) perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software.
Our analysis revealed a mismatch between patient and OBGYN priorities when considering permanent contraception versus LARC. Many OBGYNs in our study described a preference for LARC methods over permanent contraception and often prioritized factors such as reversibility and menstrual suppression. However, many patients sought permanent contraception for reasons that were not adequately addressed by LARC methods such as method permanence, desire to avoid menstrual suppression, cancer prevention, prior negative experiences with LARC, and a preference to avoid a foreign body.
CONCLUSION(S): These results suggest that priorities in selecting a preferred contraceptive method may sometimes not be aligned between patients and clinicians and that LARC methods may not always be an acceptable alternative for patients who desire permanent contraception. The findings from this study highlight the importance of eliciting and centering a patient's goals and desires for pursuing permanent contraception during contraceptive counseling. Clinicians should be aware of the various perspectives and values patients have on these methods and include them in patient-centered share decision-making.
Our study revealed a large discrepancy between patient and obstetrician-gynecologist priorities in seeking or recommending permanent contraception. Clinicians must avoid making assumptions about a patient's priorities for a contraceptive choice to engage in truly patient-driven contraceptive counseling.
我们试图了解在产后阶段，当长效可逆避孕方法（LARC，即宫内节育器和避孕植入物）与永久性避孕相比时，患者和妇产科医生在寻求或推荐这些方法方面的优先事项，而永久性避孕是患者最初的避孕偏好。
我们采访了来自美国四个机构的81名希望采用永久性避孕措施的产后患者及其接生的妇产科医生（n = 67），以探讨患者和妇产科医生在进行永久性避孕咨询和决策方面的观点。我们使用主题内容分析法，借助NVivo 12 Pro软件对访谈记录进行分析。
我们的分析显示，在考虑永久性避孕与长效可逆避孕方法时，患者和妇产科医生的优先事项存在差异。我们研究中的许多妇产科医生表示，比起永久性避孕，他们更倾向于长效可逆避孕方法，并且常常将可逆性和月经抑制等因素列为优先考虑因素。然而，许多患者寻求永久性避孕的原因是长效可逆避孕方法无法充分满足的，例如方法的永久性、希望避免月经抑制、预防癌症、之前使用长效可逆避孕方法的负面经历，以及希望避免体内有异物。
这些结果表明，在选择首选避孕方法时，患者和临床医生的优先事项有时可能不一致，对于希望采用永久性避孕措施的患者来说，长效可逆避孕方法可能并不总是可以接受的替代方案。这项研究的结果凸显了在避孕咨询过程中，引出并关注患者采用永久性避孕措施的目标和愿望的重要性。临床医生应该了解患者对这些方法的各种观点和价值观，并将其纳入以患者为中心的共同决策中。
我们的研究揭示了患者和妇产科医生在寻求或推荐永久性避孕措施方面的优先事项存在很大差异。临床医生必须避免对患者在避孕选择上的优先事项做出假设，以便进行真正以患者为导向的避孕咨询。
