Providers adapt shared decision making for the complexity of contraceptive counseling

Shared decision making is widely viewed as a tool to empower patients. Patients and providers make health decisions together, with the provider offering medical expertise and the patient sharing their values and preferences. This moves away from the paradigm of the provider serving as the authoritative decision maker. It’s an especially relevant model for serving people seeking contraception, but little is known about how it plays out in those visits.

Researchers from the Bixby Center and the UCSF Department of Family and Community Medicine did an in-depth analysis of how shared decision making plays out in counseling visits for birth control.

Providers would often start out developing a rapport, asking questions about the patient’s personal life before getting into information on birth control. In typical shared decision making, a provider would go through distinct phases in sequence: offering information, deliberating with the patient, and then making a decision. In contraceptive counseling visits, the first two steps were integrated in a back and forth to narrow options, going through pros and cons of different options based on the patient’s preferences.

Providers sometimes suggested birth control methods, but they were ultimately deferential to whatever the patient decided. Most women who went in with a preference ultimately chose that method, but some did choose a different method based on the provider giving them information about side effects or why using the method would be medically inadvisable for them.

There are a number of factors that make contraceptive counseling unique, impacting how shared decision making plays out in this context. Talking about birth control is more personal and intimate. Depending on their parameters, women could have more than 10 contraceptive methods to choose from, adding to the complexity of the discussion. Unlike with other medical issues, women use birth control for decades of their lives and often go into the visit with existing preferences and knowledge.

Previous studies have shown that shared decision making improves patients’ experiences and is associated with better health outcomes. This research can be used as a foundation to develop and implement training on shared decision making tailored to the complexity of contraceptive counseling with the ultimate goal of supporting reproductive autonomy.