Davidson, Alexandra V., and Faith M. Butler. "Physician Dispositions Toward Noninvasive Non-Hormonal Contraception." Kansas Journal of Medicine, vol. 16, no. 1, 2023, pp. 94-104.
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RRM Academy Synopsis
Physicians scored 35% to 55% on fertility awareness method knowledge
Physicians answered 35% to 55% of key-concept questions on fertility awareness-based methods (FABMs) correctly, a cross-sectional survey of 79 physicians at the University of Kansas School of Medicine found. OB/GYN and family medicine physicians scored highest. About 4 out of 10 said yes to including FABMs in contraceptive counseling.
Study at a glance, cross-sectional survey of 79 physicians: Physicians scored 35% to 55% on FABM knowledge questions. Source: Davidson AV et al., 2023, PMID 37124100.
Key Findings
OB/GYN physicians scored 55% correct (n = 16), family medicine 55% (n = 47), internal medicine 36% (n = 10) and pediatrics 35% (n = 6) on FABM concept questions.
Asked about including FABMs in contraceptive counseling, 42% (n = 35/84) said yes, 24% (n = 20/84) said sometimes and 34% (n = 29/84) said no.
Only 23% of participants correctly identified the CDC typical-use efficacy range of 77-98%; fewer than 25% of the 35 who said yes to including FABMs answered correctly.
Ineffective was the most frequent reason for including FABMs only sometimes or not at all, given 15 times: 12 by respondents who said no and 3 by those who said sometimes.
Of the 79 respondents who completed the survey, 97% (n = 77/79) answered correctly that mucus changes in the cervix can serve as a reliable fertility marker.
Interpretation
A cross-sectional survey collects answers from one group at one point in time. The 79 physicians who completed it practiced pediatrics, internal medicine, family medicine, or obstetrics and gynecology, and were invited by email through the medical school. Group sizes ranged from 6 pediatricians to 47 family medicine physicians. The authors note that taking part was voluntary and that selection bias and social desirability bias may have shaped answers. They propose that education on efficacy, the physiology behind the methods and historic knowledge gaps could address most of the concerns physicians listed.
RRM Context
Restorative reproductive medicine is informed by cycle charting. Cervical mucus and basal body temperature let a woman who ovulates estimate her chance of conception on a given day. The Creighton Model FertilityCare System is a cervical mucus-based method. Nearly all respondents reported familiarity with these mucus and temperature changes, a base for teaching charting. Body literacy, a reason the authors list for patients choosing FABMs, is a core goal of restorative care.
Our editorial summary of this paper, not the article's abstract.
Abstract
Introduction
Evidence-based, nonbiased, counseling on contraceptive options, followed by shared decision-making, is key in facilitating reproductive justice in a diverse population. An estimated 3% of contraceptive users in the United States use fertility awareness-based methods (FABMs) for contraception, and demand for these methods is increasing. FABMs can be a highly effective form of family planning when used in accordance with evidence-based protocols. They are preferred by some patients due to medical contraindications to hormonal contraceptives, lack of side effects, religious convictions, preference to avoid hormones or contraceptive devices, improved body literacy, or a combination of the above. FABMs are infrequently covered in medical school curricula and are often perceived by physicians to be of low efficacy. There is an opportunity for improvement of physicians' evidence-based knowledge of FABMs, which has the potential to improve patient understanding of and access to the full menu of family planning options.
Methods
A self-administered, cross-sectional survey was distributed to assess physician knowledge and opinions of FABMs by key university contacts. Univariate and bivariate statistics were calculated for close-ended questions and responses to open-ended questions were analyzed for common themes.
Results
A total of 79 participants completed the entire survey. Another 11 submitted partially completed surveys. For completed surveys, questions assessing knowledge of key concepts underlying FABMs, performance by specialty was 55% correct for OB/GYN (n = 16), 55% (n = 47) correct for family medicine, 36% (n = 10) correct for internal medicine, and 35% (n = 6) correct for pediatrics. Negative, neutral, mixed, and positive opinions related to FABMs were represented.
Conclusions
There are opportunities to improve physicians' evidence-based knowledge of FABMs; this may improve patient-centered contraceptive care.
Contraception › Family Planning Use and Attitudes › Attitudes and Acceptability · Clinician Education and Training › Clinician Training › Curriculum and Competencies
Alexandra V Davidson, Faith M Butler
Alex Davidson, A Davidson, F Butler
PMID 37124100 37124100 DOI 10.17161/kjm.vol16.18958 10.17161/kjm.vol16.18958 Davidson et al. 2023, Davidson 2023
