Ab1565-HPR Perception of Rheumatologists on Sexual and Reproductive Health in Autoimmune Rheumatic Diseases: A Pan India Questionnaire-Based Study

Background: Reproductive health represents a complex challenge to rheumatologists treating women with chronic autoimmune diseases. To date, there are no studies from India that have evaluated the perceptions and practices of rheumatologists about various areas of reproductive health such as sexual health, contraception, family planning, and infertility in women of reproductive age group. There is a dilemma regarding the appropriate time to address such issues and there are various challenges faced by the doctors in addressing these due to various psychosocial barriers from the patients. Objectives: To assess whether current clinical practice routinely provides adequate response, care and counselling to alleviate concerns regarding sexual and reproductive health care in women with Autoimmune Rheumatic Diseases. Methods: A questionnaire assessing the perception and varied practices of rheumatologists to address topics like sexual dysfunction, contraception, family planning and infertility, pregnancy, and drug teratogenicity in women with autoimmune rheumatic diseases was devised as Google form and was distributed in person and via social media channels across the country. A total of 130 rheumatologists filled out the questionnaire. Data was coded and recorded in MS Excel spreadsheet program. SPSS v23 (IBM Corp.) was used for data analysis Descriptive statistics were elaborated in the form of means/standard deviations, medians/IQRs for continuous variables, and frequencies and percentages for categorical variables. Results: The mean Age (Years± SD) of rheumatologists was 44.19 ± 11.32 and 71.5% of doctors were male. 43.8% of the rheumatologists practiced for more than 10 years and 30% practiced in multiple institutions. 92.3% of rheumatologists belived that reproductive health is an important aspect of women with AIRD and concerns regarding it should be discussed by them. The time spent for discussion was highest for teratogenic drugs followed by family planning and unplanned pregnancies. The least time was spent on Sexual Health and Infertility. 69.2% of rheumatologists believed in discussing these topics at the time of diagnosis and 93.1% revisited these topics over time. 64.4 % of rheumatologists stated that they discuss these concerns with both patient and their partners. The most common barrier identified by doctors while discussing reproductive health was insufficient time during the consultation followed by the preference of a female rheumatologist by the patients. When asked whether other specialties unilaterally make decisions related to patient's health, 52.4% of rheumatologists stated that the other teams refer patients back to them for any management-related decisions in context to their autoimmune disease. Also, when asked if they discussed concerns regarding reproductive health in AIRD with gynaecologist, 61.5% of rheumatologists seldom discussed these issues with a patient's gynaecologist. However, 95.4% of Rheumatologists agreed upon a need for an interdisciplinary approach between them and obstetricians. Table 1. Conclusion: Our study illustrates a need for more holistic communication between rheumatologists and women of childbearing age with AIRDs in context to their reproductive health concerns. It is also important to have a consistent approach among rheumatologists in addressing various aspects of reproductive health care to ensure the standard of care and also to obtain better compliance. Rheumatologists need to explain to the patients the impact their disease can have on their sexual and reproductive health and vice versa. These concerns needs to be discussed with patient's partner to ensure adequate knowledge regarding safe contraception during high disease burden and use of teratogenic drugs. There is an unmet need for a collaborative approach between rheumatologists and gynaecologists to lower the risk of sexual dysfunction, unplanned pregnancies, and bad obstetric outcomes. Also, patient-centred care should be incorporated into routine clinical practice and a standard consensus amongst relevant clinicians is needed to address all of the above and remove barriers from shared decision-making in such patients. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.