Developing Best Practice in Ascertaining LMP in Adolescent

Patients

Ami CookDr Christine Ferris

Why focus on LMP?

• Biohazards from ionising radiation• Teenage pregnancies (12-18 years)• Variable understandings of patients• Parent reaction• Lack of national guidelines

Context of the limping child

Any imaging of the Pelvis or HipsFemale patient of child-bearing age

• LMP required

Key issues from theory

• Communication• Sex Education - religion & culture• Blanket Testing (surgical approach)

Communication (theory)

• Stereotypes• Skills variable between ages of adolescence• Urban/ rural variation regarding sexual

activity• "Subjects thought it was improper to ask them

about their sexual activity"

Sex education (theory)

• Religion/culture• Age - mainly delivered at age 14• Negative perceptions• Variable standard of teaching

Blanket Testing (theory)

• Validity of response• Ethical issues - consent for pregnancy test• Religious issues• Privacy issues• Professional responsibility of giving test

results

Method

• Qualitative approach• Semi structured interview• Open ended questions derived from theory• Opportunities for identifying issues throughout the

interview• Final year students• Thematic analysis of data

Advantages and limitations

• Captures people's experiences and views• Allows expression in own words important as

tacit area of practice• Identify issues• Does not give an indication on spread of

practice

Parental Presence

Key theme highlighted by negative responses received by participants. Issues described:•Emancipated minors•Confidentiality•Social and religious influences

Parental PresenceData from study:•"difficult"•"parents reluctant to leave"•"parents cause an issue when asked to leave"

Findings from literature•Some patients will withheld information if they thought it would get back to parents•12 - 15 years olds prefer no parental presence•"Every effort should be made to respect a child's privacy

Religion/culture

Participants identified this as an issue and one with little training help:•Amending practice•Lack of understanding•Changing policy and legal framework•Language barriers

Religion/cultureData from study:•"taboo subject in some cultures"•"guardian would not leave the room"•"religion is an issue but I don't know how to change my practice"•"language barriers"

Findings from literature:•Professionals should recognise barriers of different cultures•Not adapting care can be deemed discriminatory•Adjusting policy could cause religion induced conflict

Sex of Radiographer

Female participants spoke of their own preferences and male participants spoke on reflection of own experiences:•Patient preference•Discussing sexual activity•Age of patient

Sex of RadiographerData from study:•"makes a difference"•"important to younger girls"•"does affect the response"

•"young girl with a young male radiographer plus the undignified nature of radiography"

Findings from literature:•Some patients feel more comfortable with professionals of the same sex

•Do not feel comfortable discussing sexual activity

Inconsistent documentation

• Currently no standard – participants described variation between clinical placements

• Creating a standard form would promote consistency

• Radiographers can be too relaxed• Confusion can cause lack of documentation

Inconsistent documentationData from study:•"dates should be recorded and not just a signature"•"signature's not concrete evidence for a legal case"•"trusting the theatre staff"

Findings from literature:•No policy will guarantee 100% detection•Standardized form would promote continuity•Question the validity of spoken confirmation

Training needs

Participants were asked if they felt University could prepare them for this aspect of practice:•Communication with age-group not taught•Little understanding of different religions and cultures•Scenario-based teaching would be beneficial

Training needsData from study:•"scenario based sessions"•"go over the LMP dates and understand the basics"•"Uni don't prepare"

Findings from literature:•Communication is not taught •Healthcare should be age-specific•Understanding of religion and culture

Conclusions

• National Policy, Local Policy or Professional Guidance

• Standardization between trusts• Educational needs met – communication,

religion/culture, scenario-based

Further Research

• Look into the views of qualified Radiographers and compare issues raised

• Develop training needs of the student Diagnostic Radiographer

Thank You for Listening

Any Questions?