JWH eBook - 6

EXPERT PANEL DISCUSSION
Dr. Levine: I think those are excellent points that
you all brought up. We really can do a better job of
trying to provide better utilization and provision of
LARC to adolescents and our transgender community, and that is possibly where telehealth can
help facilitate this. Many of these patients have
transportation or other access issues, or they do not
have a local provider who is sensitive to their needs.
Telemedicine can help reduce these access barriers.
Where do you think there are still the most significant educational or research gaps related to
either access, counseling, or provision of LARCs
that need to be addressed where maybe, again,
telehealth might play a role?
Dr. Lambing: When we think about LARC education,
there is foundational knowledge that still needs to be
communicated. There is a true talent to great counseling. When you are addressing any contraceptive or
bleeding control method, if you are thinking about any
LARC, great counseling will improve the satisfaction
of the user. Poor counseling ensures dissatisfaction. If
we do not plan ahead, that is exactly what happens.
I think that foundational knowledge is ideal, and
sometimes it gets cut a little short in favor of scheduling a procedure. Sometimes the procedure is
scheduled with another resident, so before starting the
procedure, reviewing the patient goals and expectations can add a lot of value to the patient experience
and outcome. We need to focus on counseling, and that
is foundational learning that can be done easily using
online platforms.
We share a lot of education in other areas. This is
that opportunity, because with great counseling, your
patient is going to be happy, and, more importantly,
happy people share their experience with their friends,
and that is critical when we think about our adolescents. Frequently, our adolescent patients come in
requesting a specific option, but we still need to
complete the counseling. Young people represent a
huge population for us. Autoimmune and very highrisk patients also represent a huge population for us.
Higher risk patients will not come to the clinic, so there
is great opportunity there for teaching not just autoimmune patients, but also the high-risk individuals
who are going to be great candidates for LARC. That is
foundational learning for patients and peers.
I still think you need hands-on learning, and we do
not want to miss the opportunity to emphasize that
hands-on learning is critical to this type of procedure,
as well.
Dr. Matthews: I believe the transgender population is
very misunderstood and under-represented in medicine,
so I feel like even with LARC use, there is not a lot of
understanding among the transgender patients them6

selves, but also among providers. I feel like telehealth
can also help us to understand the gap within providing
care for those kinds of patients. That would be some
really interesting research that probably we have not
even touched on yet that could be touched on, I think.
Dr. Levine: I think that those are all excellent points
in terms of the need for more research to assess if
the growing use of telehealth will help improve both
access and provision of LARCs, especially to underutilized populations.
They say it takes an average of 2 years for research evidence to get translated into practice, but I
think you will agree that outstanding evidencebased point-of-care tools that have been available
for almost a decade, such as the United States
Medical Eligibility Criteria (U.S. MEC) or Select
Practice Recommendations (U.S. SPR), remain
significantly underutilized not only out in practice,
but even in residency education programs. Perhaps
expanding remote learning opportunities will help
us translate contraceptive research evidence into
practice a lot faster. Before we end, another issue
that has received growing attention both on social
media and in scholarly articles is the concept of
''LARC Zeal,'' the overly enthusiastic promotion
of IUDs and implants at the expense of more objective and comprehensive contraceptive options of
counseling. Is ''LARC Zeal'' a significant issue in
clinical practice, and if so, how do we address this
and the broader issue of contraceptive coercion?
Dr. Matthews: Yes, I think it is real, and yes, I think
sometimes it is implicit bias of providers that they are
not aware of. How we control it is that during our
training programs, we focus our residents on patientcentered counseling. I often have residents who are not
able to get a patient to say they want an LARC or even
want any contraception at all, and they come out
saying, ''Oh, I failed. I did not get her to say she
wanted a contraception.'' And I said, ''No. Did you
counsel her? Did you tell her all her options?'' And she
said, ''No.'' Then I said, ''You did not fail. You provided her with patient-centered information, and you
made sure that she was aware of all her choices, and
she chose that at this moment this is not for her.''
I think we really need to refocus our energy on our
trainees and our peers, making sure that they are aware
that even though a patient did not choose what you
recommended for them, it does not mean that you
failed. The focus needs to be on patient-centered care
as we continue promoting LARC as an effective
contraception.
Dr. Lambing: From the perspective of education, we
have done a great job in a training process ''top down''
ª 2020 by Mary Ann Liebert, Inc.



JWH eBook

Table of Contents for the Digital Edition of JWH eBook

JWH eBook - Cover1
JWH eBook - Cover2
JWH eBook - A
JWH eBook - B
JWH eBook - C
JWH eBook - D
JWH eBook - 1
JWH eBook - 2
JWH eBook - 3
JWH eBook - 4
JWH eBook - 5
JWH eBook - 6
JWH eBook - 7
JWH eBook - 8
JWH eBook - Cover3
JWH eBook - Cover4
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