Requesting early removal of long-acting reversible contraception: a qualitative study exploring the experiences of doctors working in primary care
Jacqueline Ding A C , Henrietta Williams A B , Jane S. Hocking A and Jacqueline Coombe AA Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, L3, 207 Bouverie Street, Parkville, Vic. 3010, Australia.
B Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.
C Corresponding author. Email: jacqueline.ding@mcri.edu.au
Australian Journal of Primary Health 27(6) 467-472 https://doi.org/10.1071/PY21054
Submitted: 4 March 2021 Accepted: 27 July 2021 Published: 19 November 2021
Abstract
Long-acting reversible contraceptives (LARC) are the most effective contraceptive methods available in Australia and are effective for between 3 and 8 years. Early LARC removal (<12 months of use) can lead to gaps in contraceptive cover, exposing women to the risk of unplanned pregnancy. This study explored the experiences of doctors working in primary care (GPs and sexual health physicians) when asked to remove LARC earlier than expected. From May to July 2020, 13 doctors in Melbourne, Australia, were interviewed. Overall, participants felt conflicted about early LARC removal requests; participants highlighted the importance of respecting patient autonomy, but many felt that patients should ideally persist with LARC longer. Participants found balancing a desire to respect patients’ autonomy with their clinical responsibility challenging. Doctors used reassurance, delaying tactics and treatment of side effects to try and prolong LARC use. However, this balancing act led many doctors to perceive a tension between themselves and their patients when early LARC removal was requested. Incorporating professional education addressing these issues may help primary care providers better anticipate and navigate the tension surrounding early LARC removal consultations and maintain effective doctor–patient relationships.
Keywords: conflict, contraceptive care, doctor–patient relationship, primary care providers.
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