Aiding Contraception

Author : Christine Dehlendorf
Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (139 download)

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Download or read book A Decision Aid to Help Women Choose and Use a Method of Birth Control written by Christine Dehlendorf and published by . This book was released on 2019 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: The quality of contraceptive counseling has important implications for women's experience of family planning care and reproductive health outcomes. Studies suggest substantial room for improvement in the patient-centeredness of contraceptive counseling. Decision aids can help facilitate shared decision-making (SDM), a patient-centered counseling approach that is appropriate for preference-sensitive decisions such as those about contraception. We developed a decision support tool, My Birth Control, to support SDM in contraceptive counseling. OBJECTIVES: We examined (1) whether My Birth Control increased contraceptive continuation and improved patient experience and knowledge compared with usual care, (2) how implementation of My Birth Control affected counseling delivered by providers, and (3) how implementation of My Birth Control impacted providers and health care settings. METHODS: We conducted a cluster randomized controlled trial of contraceptive counseling with My Birth Control compared with usual care at 4 clinics serving low-income, racially/ethnically diverse populations in the San Francisco Bay Area. Participating providers (nurse practitioners, nurse midwives, physician assistants, and health educators) were randomized to the tool or to usual care. Patients seeing these providers who reported to research staff that they wished to discuss changing or starting a contraceptive method during their visit were recruited for participation. Consenting participants then either did or did not interact with the tool, according to the arm of their provider. Interacting with My Birth Control consisted of viewing the interactive web-based tool, which provided education about contraceptive methods and elicited preferences related to contraceptive use. Following completion of the tool, a printout was generated with information about these preferences, and was given to the provider for use during the visit. Patient participants were then seen by their provider for care, including contraceptive counseling. Our primary outcome was contraceptive continuation at 7 months. Secondary outcomes included patient experience of counseling, quality of decision-making, and knowledge; qualitative evaluation of counseling quality; and provider experience with counseling patients who had used the tool. To assess patient outcomes, we used baseline, 4-month, and 7-month surveys. To assess provider outcomes, we used baseline and follow-up surveys, clinic visit audio recordings, and provider interviews. We assessed clinic staff outcomes using staff focus groups. We used mixed effects regression models for quantitative outcomes and explored potential modification of the effect of treatment assignment for outcome variables with evidence of a statistically significant overall intervention effect by 5 prespecified factors: patient age, race and ethnicity (combined), language, parental education, and clinic. We used thematic coding of interviews, focus groups, and audio recordings for qualitative outcomes. RESULTS: Twenty-eight providers and 758 patients enrolled in the trial. In addition, we audio-recorded 64 patient visits before the start of the trial and 31 patient visits after the trial. Patient intervention participants (56.6%) and control participants (59.6%) did not differ in contraceptive continuation at 7 months (odds ratio [OR], 0.89; 95% CI, 0.65-1.22). More intervention participants (66.0%) reported the highest level of interpersonal quality of counseling compared with control participants (57.4%) (OR, 1.45; 95% CI, 1.03-2.05). More intervention participants reported complete satisfaction with information given about side effects (83.5%) compared with control participants (75.7%) (OR, 1.61; 95% CI, 1.11-2.33). More intervention participants (50.5%) gave the highest rating on the informed decision subscale of the Decisional Conflict Scale (DCS) compared with control participants (43.2%) (OR, 1.34; 95% CI, 1.00-1.80). We found no modification of these effects by patient characteristics, including whether they used the tool in English or Spanish. Providers reported a positive experience with My Birth Control and low impact on their work setting. Audio recordings of visits showed providers engaged more with patient preferences during visits in which patients used the tool, including preferences for methods and method characteristics. CONCLUSIONS: Our results indicate that patients who use My Birth Control experience more patient-centered counseling and higher decision quality than those who receive usual care. The tool did not impact contraceptive continuation, but because it improved patient experience and was acceptable to providers, this study supports use of My Birth Control to enhance patient-centeredness in counseling. LIMITATIONS: Limitations of our trial include the potential for contamination across groups and lack of blinding of patients and providers. This trial examined routine counseling, so we need further research to understand use of the tool by women with more complex counseling needs.