Pediatric hematology providers' contraceptive practices for female adolescents and young adults with sickle cell disease: A national survey.
Pediatric hematology providers' contraceptive practices for female adolescents and young adults with sickle cell disease: A national survey.
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DOI：
10.1002/pbc.29877
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发表时间：
2022-10
影响因子：
3.2
通讯作者：
中科院分区：
文献类型：
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患有镰状细胞病（SCD）的青少年和年轻成年（AYA）妇女的妊娠相关健康风险增加，并被处方潜在致畸药物，但有关儿科SCD提供者避孕措施的数据有限。我们的目的是评估儿科血液学提供者的信念，实践，动机和障碍，为女性AYA与SCD提供避孕保健。在健康信念模型（HBM）的指导下，我们开发了一个25个问题的基于网络的调查来评估实践。调查链接通过其公开电子邮件在全国范围内分发给儿科SCD和/或一般血液学提供者，并应美国认可的儿科血液学-肿瘤学奖学金项目负责人的要求分发给其SCD提供者。资料分析采用描述性统计、卡方分析、Logistic回归分析。在177名受访者中，分析了160份符合纳入标准的调查。大多数提供者报告咨询（77.5%）和介绍女性AYA患者避孕（90.8%），但较少报告处方避孕（41.8%）。与已建立的提供者相比，提供咨询的受训者比例更低（54% vs. 85%，p<0.001），处方趋势相似（p=0.05）。处方实践没有显着不同的供应商的信念，关于潜在的致畸性的羟基脲。主要动机包括患者的要求和性活动的披露。主要障碍包括提供者培训不足，访问时间有限，以及患者/家长的利益。供应商对患有SCD的女性AYA的避孕做法各不相同，尤其是供应商地位。关于羟基脲致畸潜力的健康信念与避孕措施无关。临床指南，提供者培训，和患者/家长的决策工具可能会进行测试，以评估是否提供避孕措施可以改善。
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 AYA with SCD. Guided by the Health Belief Model (HBM), we developed a 25-question, web-based survey to assess practices. Survey links were distributed nation-wide 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, 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 to established providers (54% vs. 85%, p<0.001), with a similar trend for prescribing (p=0.05). 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 AYA 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.
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