June 26, 2014 — Summary of "What Matters Most? The Content and Concordance of Patients' and Providers' Information Priorities for Contraceptive Decision Making," Donnelly et al., Contraception, May 1, 2014.
While imperfect contraceptive use is often "framed as failure on the part of the user," it could also "be viewed as a predictable consequence of poor alignment between a woman's unique needs, preferences and circumstances and her chosen contraceptive method," according to Kyla Donnelly of the Dartmouth Institute for Health Policy and Clinical Practice and colleagues from Dartmouth College.
The need to reduce "poor-quality contraceptive decision making ... is particularly salient given the significant expansions in access to contraceptive care and methods recently enabled by the Affordable Care Act [PL 111-148]," the researchers wrote.
They developed a study to assess and compare women's priorities for contraceptive decision-making and providers' priorities in contraceptive counseling.
The researchers developed an online survey for women ages 15 through 45 and one for health care providers. They recruited respondents through email invitations and social media postings by reproductive health groups, as well as through other email distribution lists, print publications and professional association mailing lists.
The surveys included a list of 34 common questions that might be considered in discussions between women and providers about choosing a contraceptive method. Women were asked how important the questions were to them in choosing a method, while providers were asked how important answering the questions was to them in discussing contraception with a patient.
Respondents were given six response options, including ranking the importance of the question on a scale from "not important at all" to "very important" or stating that they did not "know what this means." They also were allowed to write in as many as three of their own questions and rate their importance. Finally, respondents were asked to rank the questions they identified as "important" or "very important" in order of importance.
For each question, the researchers calculated a "mean importance rating," ranging "from 0 (not important at all) to 4 (very important)," for patients' and providers' responses. They excluded answers in which respondents said they did not understand the question.
They then determined the proportion of respondents who ranked each question among their three most important. The researchers also identified the eight questions that were most frequently ranked among respondents' top three selections.
The final sample included 417 women and 188 providers. Both groups were mostly white and not Hispanic or Latino. Most of the women had a bachelor's or higher degree (74.8%) and were trying to avoid pregnancy (76.1%). Nearly all of the providers were female (97.3%), and they were most commonly trained as nurse-practitioners (27.3%) or physicians (20.3%).
For 18 of the 34 questions, women's and providers' average importance rating was about the same. The largest areas of discordance in importance ratings were that providers rated religious acceptability, concealability of the method and method documentation on health insurance as more important than women did.
For women, "How does it work to prevent pregnancy?" was the most important question overall, while providers equally rated "How often does a patient need to remember to use it?" and "How is it used?" as most important.
"Is it safe?" was the question that appeared most frequently among women's top three questions, while "How is it used?" was most common for providers.
The eight questions that respondents most frequently selected in their top three "were related to the safety of the method, mechanism of action, mode of use, side effects, effectiveness with typical and perfect use, frequency of administration and when it begins to prevent pregnancy," the researchers found.
The study "found considerable concordance in women's and providers' information priorities, which is promising given efforts to promote shared contraceptive decision making," the researchers wrote.
However, the discordance in some areas has "important implications for patient-centered counseling practices," they added. For example, women were more likely than providers to prioritize side effects, which is noteworthy "[c]onsidering that side effects are a major cause of method discontinuation," the researchers wrote.
They noted that their "findings are particularly timely given that the [ACA] has served both to significantly expand women's access to contraceptive counseling and methods without out-of-pocket costs and to promote shared decision making and the use of decision support tools in health care more broadly."