Guidelines for Sexual and Reproductive Health Conversations for Adolescents with Cystic Fibrosis

Background: Adolescents with cystic fibrosis (CF) are sexually active at the same rate as their healthy peers and have educational needs regarding sexual and reproductive health which are both general and disease-specific. CF care team providers recognize the importance of discussing sexual and reproductive health, however many lack knowledge, comfort, and the time to address these topics with adolescents. Providing a clinical practice guideline (CPG) and education to improve confidence in addressing sexual and reproductive health is an important step to implement regular discussions in routine clinic visits. Methods: A quality improvement project was implemented in the CF clinic in the Intermountain West to improve provider's knowledge and self-efficacy in discussing sexual and reproductive health with adolescents. Provider surveys were reviewed to identify specific educational needs and previous guidelines were adapted. The CPG included information regarding disease-specific and general sexual and reproductive health topics and a timeline for discussion. The educational module included general tips regarding sexual and reproductive health, mnemonics to assist in discussion, scripting to introduce confidential time during a visit, providing inclusive care and a clinic-specific referral list. A post-intervention survey was sent to care team providers to determine their intent to change practice and to obtain feedback regarding the guideline and education. Results: Post-intervention surveys were sent to nine CF care team members and the response rate was 22.2% (n=2). Providers intend to change their practice and implement regular sexual and reproductive health into visits. Providers found the guideline useful and found the mnemonics and information regarding inclusive care most helpful in increasing their self-efficacy in providing sexual and reproductive health education. Time continues to be the largest barrier to implementing the guidelines and techniques. Conclusions: The providers found the guideline and education as helpful resources to improve their self-efficacy in conversations with adolescents regarding sexual and reproductive health. Further quality improvement work is needed to apply these guidelines to clinical practice and monitor the implementation of regular discussion with adolescents in routine visits.