Women's experiences with isotretinoin risk reduction counseling

Carly A. Werner, Melissa J. Papic, Laura K. Ferris, Jessica K. Lee, Sonya Borrero, Noel Prevost, Eleanor Schwarz

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

IMPORTANCE Isotretinoin, an effective anti-acne therapy, is a known teratogen that is strictly regulated through the iPLEDGE program. However, since this program has not significantly reduced rates of pregnancies exposed to isotretinoin, new strategies for reducing rates of isotretinoin-exposed pregnancies are needed. OBJECTIVE To explore women's experiences with counseling about isotretinoin risk reduction. DESIGN, SETTING, AND PARTICIPANTS Structured interviews were conducted between January and September 2012. Two independent coders performed content analysis using a grounded theory approach. The study participants were 16 women who had used isotretinoin to treat severe skin disease and who were recruited from a single urban community via flyers displayed on college campuses, at dermatology clinics, and at student health facilities. MAIN OUTCOMES AND MEASURES Perceptions of isotretinoin-associated risks and understanding of ways teratogenic risks can be avoided. RESULTS Participants clearly understood that isotretinoin is teratogenic but had less understanding of contraceptive methods that effectively prevent pregnancy. Most described the counseling they received as anxiety provoking. Few were counseled about highly effective reversible contraceptives such as the subdermal implant or intrauterine contraception; most counseling focused on oral contraceptives. Women cited multiple influences on their contraceptive choices, including friends, family, physicians, the internet, and other media; however, some expressed concerns about the accuracy of these sources of information. For many, iPLEDGE was their first introduction to contraception. When presented with evidence-based information on the relative effectiveness of available contraceptives, participants expressed surprise that this was not part of the iPLEDGE materials. CONCLUSIONS AND RELEVANCE Since few clinicians provide women information on highly effective (ie, intrauterine or subdermal) contraceptives, the iPLEDGE program increases anxiety about isotretinoin more than it helps women feel protected from the teratogenic risks of isotretinoin.

Original languageEnglish (US)
Pages (from-to)366-371
Number of pages6
JournalJAMA Dermatology
Volume150
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Isotretinoin
Risk Reduction Behavior
Counseling
Contraceptive Agents
Contraception
Anxiety
Teratogens
Pregnancy
Health Facilities
Acne Vulgaris
Family Physicians
Pregnancy Rate
Oral Contraceptives
Dermatology
Skin Diseases
Internet
Interviews
Students

ASJC Scopus subject areas

  • Dermatology

Cite this

Werner, C. A., Papic, M. J., Ferris, L. K., Lee, J. K., Borrero, S., Prevost, N., & Schwarz, E. (2014). Women's experiences with isotretinoin risk reduction counseling. JAMA Dermatology, 150(4), 366-371. https://doi.org/10.1001/jamadermatol.2013.6862

Women's experiences with isotretinoin risk reduction counseling. / Werner, Carly A.; Papic, Melissa J.; Ferris, Laura K.; Lee, Jessica K.; Borrero, Sonya; Prevost, Noel; Schwarz, Eleanor.

In: JAMA Dermatology, Vol. 150, No. 4, 01.01.2014, p. 366-371.

Research output: Contribution to journalArticle

Werner, CA, Papic, MJ, Ferris, LK, Lee, JK, Borrero, S, Prevost, N & Schwarz, E 2014, 'Women's experiences with isotretinoin risk reduction counseling', JAMA Dermatology, vol. 150, no. 4, pp. 366-371. https://doi.org/10.1001/jamadermatol.2013.6862
Werner CA, Papic MJ, Ferris LK, Lee JK, Borrero S, Prevost N et al. Women's experiences with isotretinoin risk reduction counseling. JAMA Dermatology. 2014 Jan 1;150(4):366-371. https://doi.org/10.1001/jamadermatol.2013.6862
Werner, Carly A. ; Papic, Melissa J. ; Ferris, Laura K. ; Lee, Jessica K. ; Borrero, Sonya ; Prevost, Noel ; Schwarz, Eleanor. / Women's experiences with isotretinoin risk reduction counseling. In: JAMA Dermatology. 2014 ; Vol. 150, No. 4. pp. 366-371.
@article{11aa2dca87b8419e91b76316c9880acf,
title = "Women's experiences with isotretinoin risk reduction counseling",
abstract = "IMPORTANCE Isotretinoin, an effective anti-acne therapy, is a known teratogen that is strictly regulated through the iPLEDGE program. However, since this program has not significantly reduced rates of pregnancies exposed to isotretinoin, new strategies for reducing rates of isotretinoin-exposed pregnancies are needed. OBJECTIVE To explore women's experiences with counseling about isotretinoin risk reduction. DESIGN, SETTING, AND PARTICIPANTS Structured interviews were conducted between January and September 2012. Two independent coders performed content analysis using a grounded theory approach. The study participants were 16 women who had used isotretinoin to treat severe skin disease and who were recruited from a single urban community via flyers displayed on college campuses, at dermatology clinics, and at student health facilities. MAIN OUTCOMES AND MEASURES Perceptions of isotretinoin-associated risks and understanding of ways teratogenic risks can be avoided. RESULTS Participants clearly understood that isotretinoin is teratogenic but had less understanding of contraceptive methods that effectively prevent pregnancy. Most described the counseling they received as anxiety provoking. Few were counseled about highly effective reversible contraceptives such as the subdermal implant or intrauterine contraception; most counseling focused on oral contraceptives. Women cited multiple influences on their contraceptive choices, including friends, family, physicians, the internet, and other media; however, some expressed concerns about the accuracy of these sources of information. For many, iPLEDGE was their first introduction to contraception. When presented with evidence-based information on the relative effectiveness of available contraceptives, participants expressed surprise that this was not part of the iPLEDGE materials. CONCLUSIONS AND RELEVANCE Since few clinicians provide women information on highly effective (ie, intrauterine or subdermal) contraceptives, the iPLEDGE program increases anxiety about isotretinoin more than it helps women feel protected from the teratogenic risks of isotretinoin.",
author = "Werner, {Carly A.} and Papic, {Melissa J.} and Ferris, {Laura K.} and Lee, {Jessica K.} and Sonya Borrero and Noel Prevost and Eleanor Schwarz",
year = "2014",
month = "1",
day = "1",
doi = "10.1001/jamadermatol.2013.6862",
language = "English (US)",
volume = "150",
pages = "366--371",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
number = "4",

}

TY - JOUR

T1 - Women's experiences with isotretinoin risk reduction counseling

AU - Werner, Carly A.

AU - Papic, Melissa J.

AU - Ferris, Laura K.

AU - Lee, Jessica K.

AU - Borrero, Sonya

AU - Prevost, Noel

AU - Schwarz, Eleanor

PY - 2014/1/1

Y1 - 2014/1/1

N2 - IMPORTANCE Isotretinoin, an effective anti-acne therapy, is a known teratogen that is strictly regulated through the iPLEDGE program. However, since this program has not significantly reduced rates of pregnancies exposed to isotretinoin, new strategies for reducing rates of isotretinoin-exposed pregnancies are needed. OBJECTIVE To explore women's experiences with counseling about isotretinoin risk reduction. DESIGN, SETTING, AND PARTICIPANTS Structured interviews were conducted between January and September 2012. Two independent coders performed content analysis using a grounded theory approach. The study participants were 16 women who had used isotretinoin to treat severe skin disease and who were recruited from a single urban community via flyers displayed on college campuses, at dermatology clinics, and at student health facilities. MAIN OUTCOMES AND MEASURES Perceptions of isotretinoin-associated risks and understanding of ways teratogenic risks can be avoided. RESULTS Participants clearly understood that isotretinoin is teratogenic but had less understanding of contraceptive methods that effectively prevent pregnancy. Most described the counseling they received as anxiety provoking. Few were counseled about highly effective reversible contraceptives such as the subdermal implant or intrauterine contraception; most counseling focused on oral contraceptives. Women cited multiple influences on their contraceptive choices, including friends, family, physicians, the internet, and other media; however, some expressed concerns about the accuracy of these sources of information. For many, iPLEDGE was their first introduction to contraception. When presented with evidence-based information on the relative effectiveness of available contraceptives, participants expressed surprise that this was not part of the iPLEDGE materials. CONCLUSIONS AND RELEVANCE Since few clinicians provide women information on highly effective (ie, intrauterine or subdermal) contraceptives, the iPLEDGE program increases anxiety about isotretinoin more than it helps women feel protected from the teratogenic risks of isotretinoin.

AB - IMPORTANCE Isotretinoin, an effective anti-acne therapy, is a known teratogen that is strictly regulated through the iPLEDGE program. However, since this program has not significantly reduced rates of pregnancies exposed to isotretinoin, new strategies for reducing rates of isotretinoin-exposed pregnancies are needed. OBJECTIVE To explore women's experiences with counseling about isotretinoin risk reduction. DESIGN, SETTING, AND PARTICIPANTS Structured interviews were conducted between January and September 2012. Two independent coders performed content analysis using a grounded theory approach. The study participants were 16 women who had used isotretinoin to treat severe skin disease and who were recruited from a single urban community via flyers displayed on college campuses, at dermatology clinics, and at student health facilities. MAIN OUTCOMES AND MEASURES Perceptions of isotretinoin-associated risks and understanding of ways teratogenic risks can be avoided. RESULTS Participants clearly understood that isotretinoin is teratogenic but had less understanding of contraceptive methods that effectively prevent pregnancy. Most described the counseling they received as anxiety provoking. Few were counseled about highly effective reversible contraceptives such as the subdermal implant or intrauterine contraception; most counseling focused on oral contraceptives. Women cited multiple influences on their contraceptive choices, including friends, family, physicians, the internet, and other media; however, some expressed concerns about the accuracy of these sources of information. For many, iPLEDGE was their first introduction to contraception. When presented with evidence-based information on the relative effectiveness of available contraceptives, participants expressed surprise that this was not part of the iPLEDGE materials. CONCLUSIONS AND RELEVANCE Since few clinicians provide women information on highly effective (ie, intrauterine or subdermal) contraceptives, the iPLEDGE program increases anxiety about isotretinoin more than it helps women feel protected from the teratogenic risks of isotretinoin.

UR - http://www.scopus.com/inward/record.url?scp=84898485785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898485785&partnerID=8YFLogxK

U2 - 10.1001/jamadermatol.2013.6862

DO - 10.1001/jamadermatol.2013.6862

M3 - Article

C2 - 24258663

AN - SCOPUS:84898485785

VL - 150

SP - 366

EP - 371

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

IS - 4

ER -