Please Be Careful with Me: Discrepancies between Adolescent Expectations and Clinician Perspectives on the Management of Pelvic Inflammatory Disease

Abstract

Study objective: To compare clinician perspectives for the treatment of pelvic inflammatory disease (PID) with those of adolescent patients and parents.

Design: Cross-sectional study.

Setting: Urban academic pediatric and adolescent medicine practices and school-based health clinics in a large urban community with a high prevalence of sexually transmitted infections and a national sample of adolescent-serving clinicians.

Participants: Female patients aged 12-19 years, parents raising an adolescent older than the age of 12 years in the urban community, and clinicians who serve adolescents recruited from regional and national listservs.

Interventions: None.

Main outcome measures: Visual analogue scale scores on a scale of 0-10 corresponding to preferences on patient disposition in 17 clinical scenarios for a hypothetical patient with PID.

Results: Compared with adolescents, clinicians were significantly more likely to endorse hospitalizations when patients presented with severe or complicated illness (β = 0.9; standard error [SE], 0.22; P < .001), possible surgical emergency (β = 0.83; SE, 0.2; P < .001), concurrent pregnancy (β = 0.59; SE, 0.3; P = .046), or failure of outpatient treatment (β = 0.58; SE, 0.29; P = .045). Compared with clinicians, adolescents were significantly more likely to endorse hospitalizations when patients presented at a young age (β = 1.36; SE, 0.38; P < .001), were homeless (β = 0.88; SE, 0.32; P = .007), were afraid to inform a partner (β = 1.66; SE, 0.40; P < .001), or had unaware parents (β = 2.86; SE, 0.39; P < .001).

Conclusion: Clinicians were more likely to recommend hospitalization when doing so adhered to national guidelines on PID treatment. Adolescents opted for hospitalization more often than clinicians in scenarios in which patients exhibited social vulnerability. Clinicians should engage with adolescents in shared disposition planning and use a more nuanced approach to PID management for adolescents who might not be able to tolerate an outpatient regimen.

Keywords: Adolescent behavior; Attitudes of health personnel; Health care surveys; Pelvic inflammatory disease; Sexually transmitted diseases.