title: Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity, and quality of communication.
abstract: OBJECTIVE
  Family planning discussions are an important aspect of medical care for women with systemic lupus erythematosus (SLE) as active disease is a risk factor for poor pregnancy outcomes, and the medications used for treatment can be harmful to the fetus when used during conception and pregnancy. Our objective was to examine the impact of patient perception of quality and type of communication on receiving contraception counseling.
  
  
  METHODS
  Data were derived from patients enrolled in the University of California, San Francisco Lupus Outcomes Study. Individuals participate in a yearly structured telephone interview that includes assessment of contraception counseling when starting new medications, and measures of communication and decision making. Logistic regression was performed to identify predictors of not receiving contraception counseling.
  
  
  RESULTS
  Of the 68 women included in this analysis, one-third did not receive contraception counseling when starting new medications. Older age, white race, depressive symptoms, and higher SLE disease activity were independently associated with not receiving contraception counseling. Participants who did not receive contraception counseling rated their physicians lower in shared decision-making (SDM) communication.
  
  
  CONCLUSIONS
  This study demonstrates a gap in family planning counseling among women with SLE starting new medications. Future studies to address these potential areas of intervention, including education about the need for contraception through menopause, and mechanisms to engage in SDM surrounding contraception are needed to improve quality of care for women with lupus.
authors.affiliation: University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA sancia.ferguson@ucsf.edu.
authors.forename: S
authors.initials: S
authors.lastname: Ferguson
authors.affiliation: University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Trupin
authors.affiliation: University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Yazdany
authors.affiliation: University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Yelin
authors.affiliation: Portland Veterans Affairs Medical Center, Division of Hospital & Specialty Medicine, Portland, OR, USA.
authors.forename: J
authors.initials: J
authors.lastname: Barton
authors.affiliation: University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Katz
mesh_terms: D000328:Adult; D003142:Communication; D003267:Contraception / Q000379:methods* / Q000592:standards; D003376:Counseling / Q000592:standards; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000592:standards; D005006:Ethnicity; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007407:Interviews as Topic; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D019984:Quality Indicators, Health Care / Q000592:standards; D044469:Racial Groups; D018570:Risk Assessment; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012720:Severity of Illness Index; D013689:Telephone
chemical_list: D007166:Immunosuppressive Agents
keywords: Contraception; family planning; systemic lupus erythematosus; teratogen