Why Do You Want It Out?: Provider Perspectives on Early LARC Removal [7S]

Abstract

INTRODUCTION: Providers promote long-acting reversible contraception (LARC) because LARCs are highly effective at preventing pregnancy. The FDA recommends a maximum length of time for LARC use, but not a minimum. When women requesting early LARC removal perceive resistance from their providers, frustration and damaged patient-provider relationships can result. Understanding provider attitudes and practices about LARC removal is vital to patient-centered care. METHODS: Ten interviews were conducted with LARC providers and analyzed using qualitative techniques. LARC providers included physicians and mid-level providers in Ob/Gyn, pediatrics, and family medicine, in academic and community settings. Transcribed interviews were coded for themes and analyzed using a modified grounded theory approach. NVivo software was used for analysis. RESULTS: Providers defined early LARC removal as two weeks after insertion to anything prior to device expiration. Providers highlighted the importance of respecting patient autonomy when early LARC removal was requested, but many felt that patients should try LARC for a minimum amount of time to acclimate to the device or because of cost. Providers want to know why LARC removal is desired so that patient can be reassured and side effects can be treated to possibly delay or prevent removal. Many providers expressed internal conflict about early removal. They felt strongly about the benefits of LARC and disappointment or irritation with patients when LARC is removed early. CONCLUSION: Providers feel conflicted between their desire to promote effective birth control and patient requests for early LARC removal. Training around LARC provision and removal should include emphasis on the importance of patient-centered care.

Claims in the clinic: A qualitative group interview study on healthcare communication about unestablished side effects of the copper IUD

“…While HCPs generally agreed that removal should be granted, some voiced a degree of reluctance. Although such reluctance is at odds with the principle of patient autonomy central to PCC, it is in line with previous research pointing patients who have met resistance when wanting to have their copper IUDs removed [26,32,35,99,104,105,111]. In correspondence with our results, previous research also indicates that some caregivers have leaned toward coercive practices to encourage LARC use [31,106], including resisting LARC removal (e.g.…”

“…Morison et al [ 33 ] note that expert-directed decision-making in contraceptive care, in which patient knowledge or concerns are not considered, may lead to covert patient resistance through discontinuation of contraceptive use. Poor PCC in contraceptive care can also damage the patient-provider relationship [ 34 , 104 , 105 ] and increase distrust in healthcare [ 26 , 106 ]. In other contexts too, such as among patients with contested diseases [ 107 ], distrust in medicine and withdrawal from care-seeking have been related to experiences of feeling deprioritized or badly treated by caregivers [ 6 , 39 , 40 , 108 ].…”

“…A clinical environment where it is not unusual for patient concerns with contraceptive side effects to be dismissed is not likely to strengthen trust in healthcare. We therefore join scholars arguing for training in and reflection on PCC in contraceptive care [ 28 , 30 , 104 ], with attention aimed towards epistemic humility [ 39 ] and cases characterized by medical uncertainty or complexity [ 79 ].…”

Increasing Access to Intrauterine Devices and Contraceptive Implants

“…U. 39 In addition to deceptive and forced sterilizations, contraceptive coercion practices that focus on those with low incomes and people of color are not only historical but continue to the present day. Oral contraceptive experimentation without consent on Puerto Rican women in the 1950s, mandates making receipt of public assistance contingent on the use of contraceptive implants or injections beginning in the 1990s, and contraceptive initiatives directed toward certain marginalized communities, ongoing even today, are all examples of reproductive injustices in this country.…”

“…Participants who were offered a range of contraceptive options and time for deliberation described greater autonomy and satisfaction. 39 Another study indicated that patients, particularly people of color, felt that their preferences regarding contraceptive selection or removal were not honored due to health care practitioner biases and systemic racism. 40 Health care professionals should provide all patients with comprehensive, scientifically accurate information about the full range of available contraceptive options.…”