Attitudes and Beliefs about Emergency Contraception in Patients at an Academic Family Medicine Clini

1
Attitudes and Beliefs about Emergency
Contraception in Patients at an Academic Family
Medicine Clinic

• John W Campbell MD
• Stephen C Busby MD
• Trident Family Medicine Residency Program

2
Background

• Epidemiology
• 43 million women of reproductive age are sexually
  active
• Roughly 6 of women ages 18-44 have used
  Emergency Contraception (EC)

3
Background

• ECs major mechanisms of action
• Prevention of ovulation
• Preventing joining of sperm and egg
• Preventing implantation of a fertilized egg

4
Background

• EC is marketed to physicians and patients as
  non-abortifacient and will not interfere with
  established pregnancy.
• This is based on the principle that the drug will
  not interfere with an implanted pregnancy.
• Emergency Birth Control Pills will not cause an
  abortion.
• The South Carolina Emergency Contraceptive
  Initiative
• EC is safe and effective and will not cause an
  abortion.
• AFP INSERT REFERENCE HERE IE. SMITH ET AL,
  AUGUST 15, 2005
• Plan B will not work if you are already
  pregnant.
• Plan B Consumer Home Page

5
Background

• Problem
• Patient perception of ECs mechanisms is poorly
  understood.
• Some patients may consider fertilization to be
  the beginning of pregnancy, causing
  misunderstanding when told EC will only work
  before pregnancy starts.
• Some patients may consider the prevention of
  implantation an abortion, thus making EC possibly
  abortifacient in their eyes.
• Correct understanding of ECs mechanisms of
  action may change patients decision making, and
  would thus be central to informed consent.

6
Background

• Source of problem Definition Variability
• Conception
• Websters conception fertilization
• Stedmans conception fertilization
• Tabers conception implantation
• Pregnancy
• Websters state of being with child
• Stedmans the state of the female after
  conception fertilization
• Tabers the condition after successful
  conception implantation. The average duration
  of pregnancy is about 280 days.

7
Purpose

• To evaluate patients understanding of the
  mechanisms of EC and terminology surrounding
  pregnancy in our patient population
• To identify any demographic variables related to
  their knowledge

8
Methods

• Cross-sectional anonymous survey distributed at
  Trident and MUSC family medicine clinics.
• Survey developed and pilot tested for appropriate
  reading level and ability to analyze results.

9
Methods

• Dates 2/06 4/06, 10/06-11/06
• Collected at University Family Medicine and MUSC
  Family Medicine clinic
• Females, ages 18-50
• Approved as exempt by MUSC IRB
• Statistical analysis
• Logistic regression

10
Results

• 178 surveys
• 81 believe conception begins with fertilization
• 47 believe pregnancy begins with fertilization
• 32 believe it would be an abortion to stop a
  pregnancy after fertilization

11
I understand conception to be the point at which
______
12
Pregnancy begins when ____
13
I would consider it an abortion to stop a
pregnancy from progressing any time after ______
14
It is my understanding that Emergency
Contraception will only work before ______
15
Results

• 41 believed it would be wrong to stop a
  pregnancy after fertilization.
• 37 would only use EC if it worked before
  fertilization or implantation.
• 34 said they would only use EC if their doctor
  said it would not cause an abortion.

16
Results

• Logistic Regression
• Race, education, and strength of religious belief
  was not associated with any emergency
  contraception beliefs
• life, pregnancy, and conception begin with sperm
  and egg joining
• abortion is stopping a pregnancy after sperm and
  egg join
• it is wrong to stop a pregnancy from progressing
  past sperm and egg joining
• EC will only work prior to sperm and egg joining

17
Discussion

• Almost all women surveyed did not fully
  understand or were unclear of ECs mechanisms of
  action.
• To inform patients that EC is not an
  abortifacient, or will definitely not work after
  they become pregnant could be misleading to a
  significant proportion of patients.
• These results raise serious questions about the
  quality of informed consent in the use of EC.
• Physicians and pharmacists must be careful of the
  terminology used when discussing EC as patient
  definitions could differ significantly.

18
(No Transcript)