(26) Clinician Perspectives on the Feasibility and Acceptability of Contraceptive Counseling for Adolescents in the Pediatric Emergency Department

Background: Many adolescents in the United States seek primary care services in the emergency department (ED). Recently, hospitals across the country have leveraged pediatric EDs as sites for contraceptive counseling and initiation of methods for adolescents who desire contraception. In this study, we explore the feasibility and acceptability of contraceptive counseling and initiation of contraceptive methods in the pediatric ED through in-depth interviews with a variety of stakeholders at the University of North Carolina Medical Center in Chapel Hill, North Carolina.

Methods: We recruited clinicians who care for adolescents in the ED via email to participate in in-depth interviews via Zoom. A total of four clinicians participated in this study, including one pediatric emergency medicine physician, two OB/GYN physicians, and one general pediatrics resident physician. Interviews were audio-recorded and transcribed. We analyzed qualitative data by thematic content analysis using an initial codebook with concepts and themes deductively derived from the interview guide and existing literature. This study was determined to be “Not Human Subjects Research” by the Institutional Review Board at UNC.

Results: Key themes arising from the focused interviews are organized into four distinct categories: (1) ED-specific considerations, (2) clinician-specific considerations, (3) patient-specific considerations, and (4) proposed workflow considerations. ED-specific considerations included time constraints, privacy, pain management, and financial costs. Clinician-specific considerations included scope of practice and comfort in offering counseling. Patient-specific considerations included medical comorbidities and whether contraceptive counseling at the time of an ED visit was appropriate. Proposed workflow considerations included the provision of contraception in the ED versus outpatient referral, universal versus targeted counseling protocols, and access to long-acting contraception device removal. The findings from these four categories are further summarized in the following four emerging considerations for program implementation: (1) balancing patient autonomy and potential coercion, (2) logistical challenges, (3) clinician preparedness, and (4) upholding principles of reproductive justice.

Conclusions: Future studies investigating the feasibility and acceptability of contraceptive counseling interventions for adolescents in the pediatric ED should specifically address these domains to guide successful program implementation planning and promote quality, equitable reproductive healthcare for adolescents.