Patients Prefer Being Offered a Mirror to See Their Cervix and External Genitalia During Well-Exams while Clinician Perceptions May Create Barriers to Offering a Mirror: A Mixed Methods Study in a Primary Care Setting.

Abstract

Objective: Patient-centered care is a core value of both Family Medicine and Obstetrics & Gynecology. We sought to know if patients prefer being offered a mirror to see their cervix and external genitalia during asymptomatic speculum exams (Mirror Pelvic Exam, MPE). Additionally, we explored clinicians' (medical assistants, residents, and faculty) opinions about offering patients a mirror during exams.

Methods: The patient portion was a cross-sectional mixed-methods survey of people presenting for cervical cancer screening at a residency-based Family Medicine Clinic. Patients took a presurvey, were offered a mirror to see their external genitalia and/or their cervix during the exam, and then took a post-survey. The clinician portion was a mixed-methods survey given at the initiation of the study and after the four-month patient survey period.

Results: While only half the patients (n = 22) accepted the use of a mirror, the majority preferred being offered and felt offering a mirror should be a routine part of the well-exam. Being offered a mirror did not bother anyone. Free responses further emphasized that patients preferred being offered the MPE. Over half of clinicians (n = 51) felt the MPE was a good idea, but only a third felt it would improve patient satisfaction. Some did not offer the MPE due to thinking patients would not want the option, lack of comfort with the MPE, or concerns about slowing down clinic flow.

Conclusion: Patients prefer being offered the MPE while clinicians did not have insight into patients' preferences. Our results suggest clinician perceptions about offering the MPE are a barrier to the MPE as a standard of care.