Exploring adolescent-facing US clinicians' perceptions of their contraceptive counseling and use of shared decision-making: A qualitative study

被引:2
|
作者
Thornton, Madeline [1 ]
Mann, Emily S. [2 ]
Bullington, Brooke W. [3 ]
Hartheimer, Joline [1 ]
Arora, Kavita Shah [4 ]
Allison, Bianca A. [5 ]
机构
[1] Univ N Carolina, Sch Med, Chapel Hill, NC 27599 USA
[2] Univ South Carolina, Arnold Sch Publ Hlth, Dept Hlth Promot Educ & Behav, Columbia, SC USA
[3] Univ N Carolina, Gillings Sch Global Publ Hlth, Dept Epidemiol, Chapel Hill, NC USA
[4] Univ N Carolina, Sch Med, Dept Obstet & Gynecol, Chapel Hill, NC USA
[5] Univ N Carolina, Sch Med, Dept Pediat, 231 McNider Bldg CB 7225 333 S Columbia St, Chapel Hill, NC 27599 USA
关键词
adolescent; contraceptive counseling; shared decision-making; HEALTH-CARE; YOUNG-ADULTS; BARRIERS; PROVIDER; BIAS; PERSPECTIVES; CONTEXT;
D O I
10.1111/psrh.12283
中图分类号
C921 [人口统计学];
学科分类号
摘要
Background: Adolescent contraceptive decision-making is influenced by a number of patient and clinician-driven factors. Although the AAP continues to endorse an efficacy-based model of contraceptive counseling, many professional organizations are shifting to a shared decision-making model as the optimal approach for providing unbiased and patient-driven contraceptive counseling. While SDM is intended to reduce the influence of clinician bias, it can exacerbate inequity if a clinician tailors a conversation based on their assumptions of a patient's goals or preferences. In this qualitative study, we explored self-reported contraceptive counseling practices among US-based clinicians who see adolescent patients to assess how these practices create barriers or facilitators to SDM and person-centered contraceptive care. Methods: We interviewed 16 clinicians at the 2022 AAP Annual Meeting who counsel adolescent patients about contraception. We used thematic content analysis to analyze interview transcripts using Dedoose. Results: We identified six aspects of contraceptive counseling that clinicians commonly employed with adolescent patients. These were: (1) sociodemographic characteristics driving counseling, (2) reliance on tiered effectiveness counseling, (3) initiating counseling conversations using "ask then explain" or "explain then ask" approaches, (4) emphasis on teen pregnancy prevention, (5) the influence of method accessibility on counseling, and (6) parental involvement in decision-making and patient confidentiality. We describe how these themes align with or diverge from each component of the SDM framework. Conclusion: Clinicians in this study frequently engaged in non-patient-centered techniques during contraceptive counseling with adolescents. These findings can inform practice recommendations to support clinicians in providing high-quality contraceptive counseling using shared decision-making.
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页数:10
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