Woman-centered shared decision-making to promote contraceptive counseling: an integrative review

Silva, Roger Rodrigues da; Silva Filho, José Adelmo da; Lima, Edilson Rodrigues de; Belém, Jameson Moreira; Pereira, Rafael da Silva; Oliveira, Camila Almeida Neves de

doi:10.1590/0034-7167-2021-0104

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 75 (05) • 2022 • https://doi.org/10.1590/0034-7167-2021-0104 copy

Woman-centered shared decision-making to promote contraceptive counseling: an integrative review

Toma de decisión conjunta dirigida a la mujer para la promoción de consejo en anticoncepción: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To summarize scientific evidence on the woman-centered shared decision-making process for the promotion of contraceptive counseling.

Methods:

Integrative literature review with a sample of nine primary articles selected from MEDLINE via PubMed, CINAHL, Web of Science, Scopus, ScienceDirect, Embase, LILACS, and BDENF.

Results:

The study evidenced a comprehensive chain of segments for the development of the shared approach centered on women through counseling on contraception, fragmenting the evidence acquisition in relational elements for the choice implementation and continuation of the chosen method; systematization of consistent information for choice implementation and continuation of the method; and challenges for implementing shared decision-making.

Final considerations:

The process of woman shared decision-making centered during the consultation on contraception counseling favors the qualified choice and effective adherence to a contraceptive method based on the professional’s clinical vision adjusted to the woman’s preferences.

Descriptors:
Family Planning; Shared Decision Making; Patient-Centered Care; Contraception; Counseling

Strategy item	Components of the question	DeCS/MESH
P	Women who use reproductive planning services	Women; Family Planning
I	Shared decision making between woman and professional	Decision Support; Shared Decision Making
C	Not applicable	Not applicable
O	Woman-Centered Contraception Counseling	Contraception; Contraceptive Counseling; Patient-Centred Care

Title	Year/ Country	Objective	Method/ sample	Outcome	Level of Confidence
Nobili MP, Piergrossi S, Brusati V, Moja EA.(¹²12 Nobili MP, Piergrossi S, Brusati V, Moja EA. The effect of patient-centred contraceptive counseling in women who undergo a voluntary termination of pregnancy. Patient Educ Couns. 2007;65(3):361-368. https://doi.org/10.1016/j.pec.2006.09.004 https://doi.org/10.1016/j.pec.2006.09.00... )	2007 Italy	To evaluate a patient-centered contraceptive counseling intervention on knowledge, attitudes, and contraceptive use in a group of Italian women who requested termination of pregnancy.	Randomized controlled Prospective study 41 women	The effect of an intervention centered on the patient that explores women’s feelings, attitudes, and beliefs about contraception --addressing it cooperatively -- allowed women to adopt more favorable attitudes while choosing an effective contraceptive method and presented a positive adherence towards it.	Level 2
Dehlendorf C, Diedrich J, Drey E, Postone A, Steinauer J.(¹³13 Dehlendorf C, Diedrich J, Drey E, Postone A, Steinauer J. Preferences for decision-making about contraception and general health care among reproductive age women at an abortion clinic. Patient Educ Couns. 2010;81(3):343-348. https://doi.org/10.1016/j.pec.2010.06.021 https://doi.org/10.1016/j.pec.2010.06.02... )	2010 EUA	Provide information on women’s experiences and preferences regarding contraceptive counseling, including whether demographic characteristics are associated with the decision-making style.	Cross-sectional Prospective study 257 women	Demographic characteristics did not correlate strongly with decision-making preferences. The experiences of women receiving contraceptive counseling were associated with preferences: those who prefer autonomous decision-making reported higher levels of satisfaction with their contraceptive method and less influence from health care providers on their decision.	Level 4
Dehlendorf C, Levy K, Kelley A, Grumbach K, Steinauer J.(¹⁴14 Dehlendorf C, Levy K, Kelley A, Grumbach K, Steinauer J. Women’s preferences for contraceptive counseling and decision making. Contraception. 2012;88(2):250-6. https://doi.org/10.1016/j.contraception.2012.10.012 https://doi.org/10.1016/j.contraception.... )	2013 EUA	Assess patients’ preferences for birth control counseling, focusing on the decision-making process, to inform future efforts to conceive interventions of counseling to improve contraceptive use.	Qualitative Prospective study 42 women	A model of contraceptive counseling more consistent with the shared decision-making, in which the provider can be involved within limits, favors the encouragement of contraceptive use and adherence. In the family planning field, with a young patient population related to medical assistance areas and the need to consider personal and sensitive issues, patients may be particularly interested in personal involvement with their specialists.	Level 6
Dehlendorf C, Kimport K, Levy K, Steinauer J.(¹⁵15 Dehlendorf C, Kimport K, Levy K, Steinauer J. A qualitative analysis of approaches to contraceptive counseling. Perspect Sex Reprod Health. 2014;46(4):233-240. https://doi.org/10.1363/46e2114 https://doi.org/10.1363/46e2114... )	2014 EUA	To report results from a qualitative analysis of contraceptive counseling visits at clinics in the San Francisco Bay Area and describe providers’ approaches to counseling and contraceptive patterns in their use.	Qualitative Prospective study 342 women 25 professionals	Three main communication approaches were revealed: closed, uninformed choice, and shared decision-making. Women advised to follow uninformed or closed choice approaches had a little discussion about what they valued in a method, and their experts did not participate in the decision-making process. Visits characterized by shared decision-making emphasized collaborative decision-making, including relationship building and active facilitation of the decision-making process to identify a method that best fit the woman’s expressed needs.	Level 6
Dehlendorf C, Henderson JT, Vittinghoff E, Grumbach K, Levy K, Schmittdiel J, et al.(¹⁶16 Dehlendorf C, Henderson JT, Vittinghoff E, Grumbach K. Association of the quality of interpersonal care during family planning counseling with contraceptive use. Am J Obstet Gynecol. 2016;215(1):78.E1-78.E9. https://doi.org/10.1016/j.agog.2016.01.173 https://doi.org/10.1016/j.agog.2016.01.1... )	2016 EUA	Determine whether the interpersonal quality assistance during contraceptive counseling is associated with their use over time.	Prospective longitudinal study 316 women 38 professionals	The quality of interpersonal assistance influences contraceptive use. In family planning treatment specifically, objective and quality measures of interpersonal assistance reported by patients predicted better contraceptive use, stressing the importance of interaction for contraceptive counseling. A defining characteristic of patient-centered assistance is emphasizing the treatment of patients as individuals, including their needs and preferences	Level 4
Carvajal DN, Gioia D, Mudafort ER, Brown PB, Barnet B.(¹⁷17 Carvajal DN, Gioia D, Mudafort ER, Brown PB, Barnet B. How can primary care physicians best support contraceptive decision making? A qualitative study exploring the perspectives of Baltimore Latinas. Women’s Health Inssues. 2017;27(2):158-66. https://doi.org/10.1016/j.whi.2016.09.015 https://doi.org/10.1016/j.whi.2016.09.01... )	2017 EUA	Identify factors influencing contraceptive decision-making among Latin American women in Baltimore.	Qualitative Prospective study 16 women	Participants strongly emphasized that effective communication and trust with professionals are crucial for decision-making. Women pointed out the support in informed decision-making over which contraceptive method was best for them, not which methods professionals thought were best for them, highlighting their autonomy of choice.	Level 6
Fox E, Reyna A, Malcolm NM, Rosmarin RB, Zapata LB, Frederiksen BN, et al.(¹⁸18 Fox E, Reyna A, Malcolm NM, Rosmarin RB, Zapata LB, Frederiksen BN, et al. Client preferences for contraceptive counseling: a systematic review. Am J Prev Med. 2018,55(5):691-702. https://doi.org/10.1016/j.amepre.2018.06.006 https://doi.org/10.1016/j.amepre.2018.06... )	2018 EUA	Summarize evidence over which preferences clients have for the contraceptive counseling they receive.	Systematic Review Retrospective 26 articles (10 database)	This review included 26 articles describing 25 studies related to client preferences for contraceptive counseling. An increasing number of studies have addressed this topic since 2011, maintaining a growing focus on patient-centeredness in healthcare in general and family planning specifically. This evidence suggests that to improve the patient-centeredness of counseling, providers can use customized approaches to elicit what information is most valuable to patients and offer personalized counseling.	Level 5
Chen M, Lindley A, Kimport K, Dehlendorf C.(¹⁹19 Chen M, Lindley A, Kimport K, Dehlendorf C. An in-depth analysis of the use of shared decision making in contraceptive counseling. Contraception. 2018;99(3):187-191. https://doi.org/10.1016/j.contraception.2018.11.009 https://doi.org/10.1016/j.contraception.... )	2019 EUA	Explore and describe how to apply shared decision making in the context of contraceptive counseling.	Transversal derived from a cohort Prospective 40 women 24 professionals	In contraceptive counseling, the stages of sharing and deliberation of information were largely integrated. By leading with questions about preferences, providers can explicitly acknowledge those preferences, build rapport with the patient, and move more efficiently through the collaborative decision-making process.	Level 4
Dehlendorf C, Fitzpatrick J, Fox E, Holt K, Vittinghoff E, Reed R, et al.(²⁰20 Dehlendorf C, Fitzpatrick J, Fox E, Holt K, Vittinghoff E, Reed R, et al. Cluster randomized trial of a patient-centred contraceptive decision support tool, My Birth Control. Am J Obstet Gynecol. 2019;220(6):565.E1-565.E-12. https://doi.org/10.1016/j.ajog.2019.02.015 https://doi.org/10.1016/j.ajog.2019.02.0... )	2019 EUA	To evaluate the effect of My Birth Control on the preventative continuation of the contraceptive treatment experience and quality of decision making.	Cluster Controlled Randomized Prospective 758 women 28 professionals	There was no observation of an effect of My Birth Control on the primary outcome of contraceptive continuation or outcomes related to a method of choice and unintended pregnancy. However, a positive impact of this decision support tool was documented on several patient-centered outcomes, including experiences in contraceptive counseling, decision quality, and knowledge of contraceptive options.	Level 2

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[1] Corresponding author: Roger Rodrigues da Silva, E-mail: roger95silva@gmail.com