CONTRACEPTIVE RISK PERCEPTION: LESSONS LEARNED FROM AN INNOVATIVE SHARED DECISION MODULE

Purpose: Development and implementation of an interactive shared decision aid to examine women’s preferences for contraception.

Method: This is a quality improvement project at our academic medical center.  Women were invited to review the web-based decision aid before their visit. The shared decision aid includes educational information on various contraceptive methods. It engages patients in a partial profile conjoint analysis experiment to quantify the relative strength of their preferences. The decision aid uses a real-time decision analysis to generate a personalized report of the patient’s preferred contraceptive method effects, and rank orders the various contraceptive options based on the patient’s input and clinical factors. We reviewed responses from the individual reports of 75 participants and analyzed the attributes influencing their contraceptive choice. 

Result: Women who completed the decision aid were mostly nulliparous (90%). Almost half of these women (48%) had painful menstrual cramps that were reported as bothersome. 41% of respondents identified prevention of unintended pregnancy as their main priority while choosing a contraceptive method. Return to fertility (20%) after discontinuation of a contraceptive method was the next most concerning ranked attribute followed by treatment intensity (9%) - how often they need to remember to use birth control. Procedural complication risks for longer acting methods, and pain or cramping with menstrual cycles were additional concerns when choosing a birth control method. Most patients preferred oral contraceptive pills (43%), followed by the birth control implant (13%). 

Conclusion: Imperfect contraception usage is a predictable consequence of mismatch between women’s unique needs, preferences, and her chosen contraceptive method.  Shared decision aids can elicit patient preferred attributes of care and treatment outcomes. This decision aid highlights that prevention of unintended pregnancy is the most important concern for women choosing a birth control method. Patient-centered contraception counseling via shared decision making is one important approach to improve contraceptive decisional quality and improving the patient-provider communication.