counseling that is respectful of, and responsive to, individual patient preferences, needs and values. This approach saves time and encourages patient decision-making and responsibility.
Effective contraceptive counseling and education is a two-way process. By asking questions and listening to what patients say, we experience bi-directional learning. Patient-centered counseling benefits patients because it addresses their concerns, focuses on their needs and results in positive health outcomes. It benefits clinicians by saving time, decreasing stress and frustration, and increasing effectiveness and professional engagement.
A range of factors can influence a patient’s choice of a contraceptive method. Personal preferences, relationship characteristics, social influences, pregnancy intentions, and cultural considerations may affect the decision-making process. The contraception care provider has an important role in assisting patients with their decisions. First, by listening to the patient—eliciting concerns, interests and goals related to pregnancy prevention. Then, by providing clear and accurate information about the full range of contraceptive options, emphasizing those most aligned with patient-expressed desires.
- Ensure clinician proficiency with one or more evidence-based or nationally endorsed patient-centered counseling techniques and approaches. Examples include:
- The Five Principles for Providing Quality Counseling, as laid out by the Center for Disease Control and the Office of Population Affairs in Providing Quality Family Planning Services.1
- Teach-Back Method: a practice based on the health literacy principles of plain language that confirms patient understanding and improves patient outcome. This method is also effective in ensuring the clinician can explain back to the patient what the clinician heard regarding the patient’s preferences.2
- O.A.R.S.: a skills-based model of interactive techniques adapted from a patient-centered approach, using motivational interviewing principles.3
- PC2 You Decide: a five-step approach to guide clinicians in helping patients choose a new contraceptive method, understand cardiovascular risks associated with combined hormonal methods, and address patient concerns.4
- Offer annual training and resources that maintain clinician knowledge and understanding of all FDA-approved contraceptive methods. Ensure contraceptive counseling reflects current practice standards.5,6,7
- Ensure clinicians have access to the most current versions (print and/or electronic) of the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 and the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 for all contraceptive counseling and education providers.5,6
- Consider training on the tiered approach to counseling. In this approach, the most effective, reversible long-acting methods are presented before less effective methods, and include methods that may not be available on-site. Tiered counseling should start at the patient’s experience level and be based on their stated preferences and goals. It is particularly important to be mindful of historic experiences of coercion and forced sterilization among communities of color and other vulnerable populations.
- As a result of counseling and education training and resources offered, clinicians should be able to demonstrate the following skills:8
- Establish rapport: The ability to establish rapport and gain insight into the patient’s personal circumstances and challenges can help the clinician to individualize information and guidance.
- Engage patients as partners in their own care: The ability to engage the patient in developing a plan that includes setting goals, discussing possible difficulties and challenging situations, and considering backup plans and follow-up (see Component 2.8: Patient Support for Contraceptive Management).
- Use education and decision aids: Appropriate use of decision aids (paper or computer-based) during the counseling visit to help patients self-assess, learn about methods, and develop questions for the clinician.
- Build trust: Competent interpersonal skills that build trust allow for greater insight into the patient’s cultural and personal context.
- Interpersonal communication skills: Nonjudgmental listening and empathy can be especially important in sexual health discussions.
- Offer training in Implicit Bias in addition to Cultural Competency. Consider innovative approaches to understanding implicit biases of clinicians, such as videotaping encounters to analyze for patterns9 and examining relevant data (e.g., examining contraceptive methods used by patients of different racial and ethnic backgrounds across individual clinicians to see whether there are differences in method provision).
- Competencies 1.3 Special Populations/Diversity and 1.4 Language/Health Literacy/Communication include strategies and resources related to the provision of culturally and linguistically appropriate counseling and education services.
- Providing Quality Family Planning Services (QFP), Recommendations of CDC and U.S. Office of Population Affairs, 2014,Appendix C – Five Principles for Providing Quality Counseling and Appendix E – Strategies for Providing Information to Clients: www.cdc.gov/mmwr/pdf/rr/rr6304.pdf
- Teach-Back Method: http://www.teachbacktraining.org
- The OARS Model, Essential Communication Skills, Center for Health Training, 2010: https://public.health.oregon.gov/HealthyPeopleFamilies/ReproductiveSexualHealth/Documents/edmat/ OARSEssentialCommunicationTechniques.pdf
- PC2 You Decide: A Five-Step Approach to the personal choice interview, risk assessment, and patient education with regards to cardiovascular risks associated with hormonal contraception: http://www.knowwhatuwant.org/uploads/pdf/ARHPs_5-step_Provider_Counseling_Guide.pdf
- Centers for Disease Control and Prevention, Reproductive Health, US Selected Practice Recommendations (US SPR) for Contraceptive Use, 2013: http://www.cdc.gov/reproductivehealth/ unintendedpregnancy/usspr.htm
- Centers for Disease Control and Prevention, Reproductive Health, US Medical Eligibility Criteria (US MEC) for Contraceptive Use, 2010: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usmec.htm
- Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol 2014 Dec; 57(4):659-73.
- Oregon Health Authority, Public Health Division, Reproductive Health Program, Client-Centered Counseling Models and Resources, 2013: https://public.health.oregon.gov/HealthyPeopleFamilies/ReproductiveSexualHealth/Documents/edmat/Client CenterCounselingModelsandResources.pdf
- Rachel L. Johnson, Debra Roter, Neil R. Powe, Lisa A. Cooper. Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits. Am J Public Health. 2004 December; 94(12): 2084–2090.