Decisional conflict associated with clinicians discouraging particular contraceptive methods

Area of Science:

• Reproductive Health
• Clinical Decision Making
• Patient-Centered Care

Background:

• Unintended pregnancies are common in the U.S., with contraception use reducing this risk.
• Initiating many contraceptive methods requires clinical consultation.
• Clinician influence on contraceptive choice warrants investigation.

Purpose of the Study:

• To explore how clinician preferences against certain contraceptive methods affect patient confidence and shared decision-making.
• To analyze the impact of clinician discouragement on patient decisional conflict and perceived shared decision-making.

Main Methods:

• Anonymous web-based survey administered via Amazon Mechanical Turk to 669 participants (aged 18-45, assigned female at birth, English-speaking, contraceptive users/previous users).
• Primary outcomes included: proportion discouraged from a method, decisional conflict, and extent of shared decision-making.
• Secondary outcomes assessed: importance of contraceptive attributes and quality of care.

Main Results:

• 33.8% of participants reported being discouraged from a contraceptive method, often due to side effects, usability, or effectiveness.
• Patients discouraged from a method reported higher decisional conflict (41.2% vs. 30.0%) but also a greater extent of shared decision-making (median 76 vs. 71).
• Nulliparity influenced the association between being discouraged and shared decision-making (P=.06).

Conclusions:

• Clinician discouragement of specific contraceptive methods can lead to patient decisional conflict.
• Discrepancies between clinician reasoning and patient preferences may occur.
• Further research is needed to enhance contraceptive counseling and support patient method selection.