This patient perspective may translate to the urology setting, but it requires further investigation.Īdditionally, a small group of patients within the urology setting who do prefer the use of a chaperone during sensitive examinations still exists ( Table 1). 5 These patients felt that a chaperone does not have a negative effect on trust in the doctor-patient relationship, does not break patient confidentiality, and does not cause embarrassment.
5 Importantly, most patients within the broad scope of obstetrics and gynecology do not believe that the presence of a chaperone has negative effects on their appointment or relationship with their physician. 8 The offer of a chaperone on its own is seen as a sign of respect for the patient in that chaperone-use becomes a patient-centered healthcare decision. 9 A later study confirmed this finding, revealing that the vast majority of urology patients, both men and women, believe that chaperones should be offered and that urological patients have the right to refuse a chaperone. In an earlier study, the majority (73%) of male urology patients felt a chaperone should be offered for every encounter while a smaller group (14%) actually prefer a chaperone to be present. Patient preference around chaperone use during urologic examinations, however, is more nuanced. While more work needs to be done to bridge the divide between clinical practice and patient/physician preferences, the act of offering chaperones to urologic patients, regardless if they want to utilize a chaperone for their examination is respectful of patient privacy and decision making. Research suggests that there are differing perspectives between patients and physicians regarding the specific role and benefits chaperones offer during a sensitive urologic examination, as well as differences in preferences of who should perform the role of the chaperone. Two studies reported the likelihood of chaperone utilization depending on gender of the physician, showing that male physicians were more likely to utilize chaperones and were 3x more likely to offer chaperones to their patients compared to female physicians. Two studies reported chaperone utilization documentation, ranging between 16-21.3%. Three studies reported the use of chaperones in the clinic which ranged from 5-72.5%. Two studies reported the percentage of patients who believed chaperones should be offered to all urology patients, ranging from 73-88.4%. One study reported that 25.6% of patients did not feel comfortable to ask for a chaperone if they were not offered one. Physicians (60%) prefer staff member chaperones compared to family members. Patients (59%) prefer a family member compared to a staff member as a chaperone. A greater proportion of these patients were male. The percentage of patients that did not have a chaperone present during their urologic exam ranged from 52.9-88.5%.
Of these, 4 studies focused on the patient perspective and 5 focused on the provider perspective. Preliminary study identification yielded 702 studies, 9 of which were eligible for this review after applying the inclusion and exclusion criteria. Studies were included if they addressed patient/provider perspectives on chaperone utilization in urology specifically and were excluded if they investigated perspectives on chaperone utilization in other specialties. Studies were identified from PubMed, MEDLINE, and PMC using the Medical Subject Headings (MeSH) terms “chaperones, patient”, “chaperones, medical”, and keywords “chaperones”, and “urology”. In the present investigation, we conducted a systematic review of prospective, case-control, and retrospective studies and followed the PRISMA 2020 guidelines for data reporting. Our aim was to summarize the patient and provider perspectives on the role of chaperones in urology as well as identify barriers to implement chaperone consistency. Despite clinical practice recommendations to offer chaperones for sensitive urologic exams, there is no data regarding the consistency of chaperone utilization. The intention of utilizing chaperones during sensitive physical exams is to show respect to the patient, while simultaneously providing protection to both the patient and the medical provider.
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