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Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study
Author(s) -
Birru Talabi Mehret,
Clowse Megan E. B.,
Blalock Susan J.,
Hamm Megan,
Borrero Sonya
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23872
Subject(s) - thematic analysis , medicine , family medicine , qualitative research , focus group , autonomy , family planning , coding (social sciences) , medical education , nursing , population , social science , statistics , mathematics , environmental health , marketing , sociology , political science , law , business , research methodology
Objective Little is known about whether and how rheumatologists provide family planning counseling and reproductive health care (FPCC) to reproductive‐age women with rheumatic diseases. This qualitative study sought to assess rheumatologists’ perspectives, attitudes, and practices regarding FPCC. Methods Semistructured interviews were conducted with a geographically diverse US sample of rheumatologists (n = 12). Interviews were transcribed verbatim, and a code book was inductively developed based on transcript content. Two coders applied the code book to all transcripts, and coding differences were adjudicated to full agreement. The finalized coding was used to conduct a thematic analysis. Results Six themes were identified across interviews. Rheumatologists said that they 1) feel responsible for providing some FPCC to patients, 2) experience tension between respecting patients’ autonomy and their own anxieties about managing high‐risk pregnancies, 3) view patient‐initiated conversations as FPCC facilitators, and they regard lack of guidelines and the presence of competing clinical priorities as barriers to FPCC, 4) are reluctant to prescribe contraception, 5) desire greater access to resources to help guide FPCC, and 6) recognize the benefits of multidisciplinary collaboration with gynecologists. Conclusion Rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive‐age female patients. However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance. Rheumatologists do not prescribe contraception but rarely refer patients to gynecologists for contraceptive care. Future work should focus on eliminating barriers and identifying solutions that support rheumatologists’ efforts to provide high‐quality FPCC to patients.