Effectiveness of a Patient Decision Aid in Immediate Postpartum Contraceptive Counseling
Condition: Contraception
Study type: Interventional

Summary: 
      Effective physician-patient communication in postpartum contraceptive counseling is essential
      for patients to meet their contraceptive needs and reduce the risk of rapid repeat
      pregnancies. This project will utilize a patient decision aid to facilitate shared decision
      making in the immediate postpartum setting, assess the effectiveness of such aid in "decision
      quality" and "decision-making process quality", and observe its effects on contraceptive
      choice mix at the time of discharge.
    

Detailed description: 
      More than 51% of pregnancies in the US are unintentional. Of the unintended pregnancies, 43%
      are attributable to incorrect or inconsistent use of contraceptive methods. Gaps in
      contraceptive use can arise from a misalignment of the patient's needs or preferences and her
      chosen method. This is particularly salient in the postpartum setting; nearly two-thirds of
      women in their first year of postpartum have unmet need for family planning, and adolescents
      in particular are at high risk for repeat pregnancies within a year.

      Effective physician-patient communication in postpartum contraceptive counseling is essential
      for patients to meet their contraceptive needs. Previously, there has been an emphasis on
      "informed choice" model for counseling, in which the clinician's role is to provide
      information to the patient in order to facilitate her choice of a contraceptive method. The
      provider does not actively participate in the process of selecting the method, in the spirit
      of respecting patient autonomy. Dehlendorf et al. has shown that while women do value
      autonomy in making a decision about their contraceptive method, they prefer more provider
      involvement in the decision making process than the "informed choice" model allows. This has
      given room for a rise in interest in Shared Decision Making (SDM) model of counseling for
      contraceptive care. In the SDM model, the clinical plays a supportive role in patient
      decision making, by not only providing information but also guiding the patient through her
      deliberation. While the final decision is left in the hands of the patient, they are given
      support to identify their preferences and needs, and to align them with an option that best
      matches her preferences and needs.

      Various decision making tools have been developed to facilitate SDM. One method is to display
      all available options in one axis, and frequently-asked questions regarding each option in
      the other axis. Patients are asked to select frequently-asked questions that address their
      concerns, thereby sorting through the most pertinent information regarding their options in
      one view. Research has shown that such patient decision aids (PtDA) help patients understand
      their options, feel more informed, participate in decision making, and have more accurate
      expectations of possible outcomes.

      The goal of this project is to utilize a PtDA to facilitate SDM in the immediate postpartum
      setting, assess the effectiveness of such PtDA on decision quality and decision-making
      process quality (as defined and measured by previously validated survey tools), and to
      observe its effects on patients' contraceptive choice at the time of discharge.
    

Intervention name(s): Patient Decision Aid; Website; Shared- Decision Making Counseling
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): One sheet of postpartum contraceptive information arranged in a grid.; Patient directed to website with information on various contraceptive methods.; Counseling using principles of shared-decision making
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other