25. Provider Self-Disclosure during Contraception Counseling in Adolescents and Young Adults

Abstract

<h3>Background</h3> Provider self-disclosure (PSD) is any statement made to a patient that includes the provider's own experience, and has the potential to be utilized by those who use the same contraception as their teenage patients. However, it is imperative to understand how providers counsel on contraception, and whether PSD is an acceptable tactic. The study goal was to describe PSD use regarding the intrauterine device (IUD) with adolescent patients. Secondary outcomes were to identify the content and context of PSD in the contraception setting. <h3>Methods</h3> An IRB-approved, anonymous survey was distributed to the NASPAG list serve. Participants were eligible if they counsel adolescents or young adults on contraception. Variables included demographics, contraceptive history, contraceptive PSD history, and comfort with other PSD statements. Questions on PSD viewpoints were adapted from prior studies. For unanswered survey questions, analysis was conducted according to the number of responses for each question. <h3>Results</h3> Of the 86 completed surveys, the majority (N=49) were pediatric & adolescent gynecologists. Sixty-one respondents have used or are currently using an IUD; the majority of the 61 IUD users (72%) have self-disclosed IUD use to an adolescent by choice, and 23% have by patient request. IUD disclosure was very rare or rare (42%, 22/53), occasional (30%, 16/53), and very frequent (17%, 9/53), and always (4%, 2/53). Providers frequently disclosed IUD use to patients' family members as well (94%, 50/53). The majority (83%, 44/53) reported age not impacting the decision to disclose IUD use. IUD PSD was most likely to occur when the patient has decided on the IUD but has questions (62%, 32/52) or when the patient was debating between fewer methods (48%, 25/52). Most providers (83%, 43/52) generally disclose their IUD experience positively (ease of use and lighter bleeding most commonly discussed). Providers felt it is usually appropriate (35%, 30/85) or neither appropriate nor inappropriate (38%, 32/85) to disclose contraception use to teens. In addition, providers felt PSD was always appropriate in both teens and adults (46%, 36/78) or more appropriate in adults than teens (27%, 21/78). The majority generally agreed that PSD enhances patient support (64%, 55/86) and develops trust (66%, 57/86), although less agreed on PSD as increasing patient motivation (43%, 37/86). Thirty-three percent of providers (29/86) thought PSD takes focus away from patients' needs. <h3>Conclusions</h3> PSD is commonly used by those who counsel on contraception and IUD use. Age does not appear to influence PSD regarding IUD or contraception use. Further research is warranted on how adolescents and young adults perceive contraceptive PSD.