title: Obstetric Health Care Providers' Counseling Responses to Pregnant Patient Disclosures of Marijuana Use.
abstract: OBJECTIVE
  To describe obstetric health care providers' responses and counseling approaches to patients' disclosures of marijuana use during first prenatal visits.
  
  
  METHODS
  We performed a content analysis of audio-recorded patient-health care provider first prenatal visits for obstetrics health care providers' responses to patients' disclosure of marijuana use. The study was conducted at five urban outpatient clinics located in Pittsburgh, Pennsylvania.
  
  
  RESULTS
  Among 468 audio-recorded first obstetric encounters, 90 patients (19%) disclosed marijuana use to 47 health care providers; mean number of recoded encounters containing marijuana disclosures for participating health providers was 1.8±1.4. In 48% of these 90 visits, obstetric health care providers did not respond to marijuana use disclosures or offer counseling. When counseling was offered, it consisted of general statements without specific information on the risks or outcomes related to marijuana use in pregnancy, discussions regarding the need for urine toxicology testing, and warnings that use detected at the time of delivery would initiate child protective services involvement.
  
  
  CONCLUSIONS
  Obstetric health care provider responses to disclosure of marijuana use occurred in approximately half of patient encounters when marijuana use was disclosed and focused on legal and procedural consequences with less focus on health or medical implications. Our results suggest a need for health care provider training on potential consequences of perinatal marijuana use and communication skills for counseling patients about perinatal marijuana.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Research Institute, the Division of General Internal Medicine, Department of Internal Medicine, Center for Research in Health Care, Clinical and Translational Science Institute, University of Pittsburgh, the Center for Health Equity Research & Promotion, Veterans Affairs Pittsburgh Healthcare System, the Department of Psychiatry, University of Pittsburgh, and the Section of Palliative Care and Medical Ethics, Institute to Enhance Palliative Care, Institute for Doctor-Patient Communication, Center for Research in Health Care, Pittsburgh, Pennsylvania.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Holland
authors.forename: Doris
authors.initials: D
authors.lastname: Rubio
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kraemer
authors.forename: Nancy
authors.initials: N
authors.lastname: Day
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Jill A
authors.initials: JA
authors.lastname: Tarr
authors.forename: Judy C
authors.initials: JC
authors.lastname: Chang
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003376:Counseling; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D002189:Marijuana Abuse / Q000175:diagnosis / Q000523:psychology*; D009774:Obstetrics / Q000379:methods; D010414:Pennsylvania; D010817:Physician-Patient Relations; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods / Q000523:psychology; D014342:Truth Disclosure; D055815:Young Adult