Beyond pain medication: striving toward more patient-centered placement of intrauterine devices

This study aimed to assess patient experiences and preferences for counseling, addressing pain and anxiety, and provider support during placement of intrauterine devices (IUDs).

This mixed-methods study included a survey and in-depth interviews of patients undergoing IUD placement. Participants reported pain, satisfaction, and importance of aspects of care during IUD placement. Ten provider behaviors measured on a Likert scale (1-5) sum to create a "provider support score" (range 10-50). We measured pain with categorical variables and a visual analog scale (0-10). We performed descriptive statistics, bivariate analysis, and multivariable analysis on survey data. Qualitative data analysis utilized inductive analytics with NVivo.

Among 79 respondents, the three factors most frequently cited as "very important" included explaining steps before the procedure (74.7%), discussing pain concerns in advance (72.2%), and being attentive to comfort during the procedure (72.2%). The mean (SD) pain score was 5.7/10 (2.8). Most participants were satisfied (24.1%) or very satisfied (62%) with their IUD placement. The mean provider support score was 32.8/50. When controlling for pain score, higher provider support scores predicted satisfaction; with each unit increase in provider support score, the odds of satisfaction increased by 69% (adjusted odds ratio 1.69). Themes emerging from qualitative data included the importance of acknowledging rather than minimizing pain experiences, setting clear and realistic expectations, and both exploring and attending to individualized patient preferences around IUD placement.

Answering the call for more patient-centered IUD placement requires not only addressing pain but also tailoring a range of supportive behaviors to each patient to improve satisfaction.

In addition to addressing pain, clinicians need to focus on a range of other supportive behaviors related to IUD placement, including clear counseling, provider empathy, and forthcoming expectation setting to make the procedure more patient-centered and improve patient satisfaction.