An in-depth analysis of the use of shared decision making in contraceptive counseling

Objective(s): Shared decision making (SDM) has emerged as a useful tool to promote patient-centered communication and is highly applicable to contraceptive decision making. Little is known about how SDM is operationalized in contraceptive counseling. This study aimed to explore and describe how SDM is used in the contraceptive counseling context.

Methods: We analyzed a selection of transcripts from a larger study of 342 audiorecorded visits in which contraceptive counseling occurred in the San Francisco Bay Area. A previous study team had identified 106 transcripts that demonstrated principles of SDM. We randomly selected 40 transcripts from this group for deeper analysis. We coded transcripts using directed content analysis to understand the process of SDM in the context of contraceptive counseling. We focused on how the previously identified phases of SDM (information sharing, deliberation and decision making) occurred in these visits and identified emerging themes.

Results: Rather than consisting of distinct phases, our analysis found that, in contraceptive counseling, the information sharing and deliberation stages of SDM were largely integrated in an iterative back and forth process between patient and provider. The final decision-making phase was directed by the patient, who retained the final choice.

Conclusion: Our analysis found that the use of SDM in the contraceptive counseling context reflected the intimacy and complexity of contraceptive decision making. These findings can be used as a foundation for future work to develop training designed to integrate SDM in a manner appropriate to the context of contraception, including prioritizing patient autonomy and acknowledging preexisting preferences of patients.