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Arthritis Care Res (Hoboken). 2019 Mar 15. doi: 10.1002/acr.23872. [Epub ahead of print]

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study.

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Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Duke University Medical Center, Durham, NC, USA.
University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
University of Pittsburgh, Pittsburgh, PA, USA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.



Little is known about if and how rheumatologists provide family planning counseling and reproductive health care (FPCC) to reproductive-age women with rheumatic diseases. This qualitative study sought to assess rheumatologists' perspectives, attitudes, and practices regarding FPCC.


Semi-structured interviews were conducted with a geographically diverse U.S. sample of rheumatologists (n=12). Interviews were transcribed verbatim, and a code book was inductively developed based on transcript content. Two coders applied the code book to all transcripts, and coding differences were adjudicated to full agreement. The finalized coding was used to conduct a thematic analysis.


Six themes were identified across interviews. Rheumatologists: 1) feel responsible for providing some FPCC to patients, 2) experience tension between respecting patients' autonomy and their own anxieties about managing high-risk pregnancies, 3) view patient-initiated conversations as FPCC facilitators, and lack of guidelines and competing clinical priorities as barriers to FPCC, 4) are reluctant to prescribe contraception, 5) desire greater access to resources to help guide FPCC, and 6) recognize the benefits of multidisciplinary collaboration with gynecologists.


Rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive-age female patients. However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance. Rheumatologists do not prescribe contraception but rarely refer patients to gynecologists for contraceptive care. Future work should focus on eliminating barriers and identifying solutions that support rheumatologists' efforts to provide high-quality FPCC to patients. This article is protected by copyright. All rights reserved.


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