Patient-provider communication before and after implementation of the contraceptive decision support tool My Birth Control.

OBJECTIVE: To compare differences in patient-provider communication among patients who, prior to contraceptive counseling, used or did not use a decision support tool ("My Birth Control") which has educational and interactive modules and produces a provider printout with the patient's preferences. METHODS: As part of a cluster-randomized trial of the tool in four San Francisco safety net clinics, we collected and thematically analyzed 70 audio recordings of counseling visits (31 pre- and 39 post-tool implementation) from 15 providers randomized to the intervention. RESULTS: Without the tool, most providers began by asking participants what method they were considering and focused counseling on that method or on directing patients towards long-acting reversible contraception; with the tool, most focused on reviewing and discussing multiple methods of interest to the participant as indicated on the printout. Discussion of patients' preferences for specific method features was not observed in pre-implementation recordings but was part of several post-implementation recordings. Several participants explicitly noted they had gained knowledge from the tool. CONCLUSION: Observed counseling differences suggest the tool may have a positive impact on patient-centeredness of contraceptive counseling, consistent with findings from the main study. PRACTICE IMPLICATIONS: My Birth Control shows potential for improving patient-centeredness in counseling without extensive provider training.

A mixed-methods study of provider perspectives on My Birth Control: a contraceptive decision support tool designed to facilitate shared decision making.

OBJECTIVES: Barriers to the provision of patient-centered contraceptive counseling include time limitations, frequent misconceptions and misinformation about methods among patients, and the availability of numerous contraceptive options, which increases the complexity of contraceptive decision making. Decision support tools are interventions designed to facilitate quality decision making in preference-sensitive decisions. We evaluated the impact of a contraceptive decision support tool, My Birth Control, on providers' experience with contraceptive counseling. STUDY DESIGN: We interviewed 15 providers who participated in the intervention arm of a cluster randomized controlled trial of My Birth Control to obtain their impressions of their patients' interactions with the tool. We analyzed the interviews using thematic analysis, compared appointment lengths of patients in each arm (n=749) and assessed provider burnout in each arm (n=28). RESULTS: Providers reported that incorporating My Birth Control into their practice helped them allocate time more efficiently, enabling them to hone in on patients' areas of interest. They also reported that patients who interacted with the tool appeared more informed about contraception options and features, and took a more active role in method selection. All providers described using the tool as acceptable and feasible, and indicated they would like to incorporate it into their practice. There was no difference in provider burnout scores comparing before and after the trial of My Birth Control. CONCLUSION: Providers had a positive impression of the impact of My Birth Control on contraceptive counseling, including the quality of counseling, and perceived the tool to be a feasible intervention to use in the clinical setting. IMPLICATIONS: Family planning clinics should consider incorporating My Birth Control into their clinical services as a means of improving contraceptive care and provider experience of counseling.

Cluster randomized trial of a patient-centered contraceptive decision support tool, My Birth Control.

BACKGROUND: Research suggests the need for improvement in the patient-centeredness and comprehensiveness of contraceptive counseling. My Birth Control is a tablet-based decision support tool designed to improve women's experience of contraceptive counseling and to help them select contraceptive methods that are consistent with their values and preferences. OBJECTIVE: The objective of this study was to evaluate the effect of My Birth Control on contraceptive continuation, experience of contraceptive care, and decision quality. STUDY DESIGN: Using a cluster randomized design, randomized at the provider level, patient participants interested in starting or changing contraception interacted with My Birth Control before their family planning visit (intervention) or received usual care (control). A postvisit survey assessed experience of care method satisfaction, decision quality, and contraceptive knowledge. Surveys at 4 and 7 months assessed the primary outcome of contraceptive continuation, along with method use, satisfaction, and unintended pregnancy. Mixed-effects logistic regression models with multiple imputation for missing data were used to examine the effect of treatment assignment. RESULTS: Twenty-eight providers participated and 758 patients enrolled between December 5, 2014, and February 5, 2016. Participants were racially/ethnically diverse; less than a quarter self-identified as white. No effect was found on 7-month continuation (56.6% and 59.6% for intervention and control group respectively, odds ratio, 0.89; 95% confidence interval, 0.65-1.22). However, assignment to the intervention group increased reporting of the greatest Interpersonal Quality of Family Planning score (66.0% vs 57.4%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), the greatest scores on the informed decision and uncertainty subscales of the Decisional Conflict Scale (50.5% vs 43.2%, odds ratio, 1.34; 95% confidence interval, 1.0-1.80 and 41.6% vs 33.3%, odds ratio, 1.45; 95% confidence interval, 1.03-2.05), and greater knowledge. CONCLUSION: My Birth Control had no effect on contraceptive continuation. The intervention did enhance the experience of contraceptive counseling and informed decision making, as well as contraceptive knowledge., The intervention's effect on patient experience is important, particularly given the personal nature of contraceptive decision making and the social and historical context of family planning care.

Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling.

OBJECTIVE: We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. METHODS: Drawing upon formative work around women's preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. RESULTS: Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool's content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. CONCLUSION: Our decision support tool appears acceptable to women in the family planning setting. PRACTICE IMPLICATIONS: Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial.