See attached.
Hi Sanithia, I think this is an interesting topic and I can imagine that adoption of shared-decision making approach in contraceptive counseling can be hard to implement given the physicians' busy schedule and the other barriers that you listed. I would be interested how contraceptive counseling is currently done in family planning services? Do patients just receive a recommendation from the physician based on the physician's own preferences and beliefs? Or is it frequently not addressed at all? Is there some data on the percentage of patients who do receive contraceptive counseling using a shared-decision approach? You have mentioned that a shared-decision model for contraceptive counseling leades to increases contraception continuation, and I was wondering if there is also data on other outcomes, such as e.g. a decrease in unwanted pregnancies / decrease in abortion rates? You have listed multiple barriers on different socio-ecological levels, are you going to focus on a specific level with your intervention?
Interested to hear more about this topic!
Hi Sanithia,
I think this is really interesting gap and very important/timely. I would like if you could explain, perhaps using a table or diagram, the differences between shared-decision making and regular counseling for contraceptives. I am not quite sure what this would require of the provider to switch from the standard method of counseling to the shared-decision model? I think trying to make a more detailed DAG and thinking of outside confounders such as patient population, education level of patients, etc. would be useful in narrowing down what socio-ecological level you would like to focus on. It looks like you are leaning towards the health care worker level. If so I think you should consider not just the providers but also supporting staff. I am also curious what type of a clinic you would be targeting. Is this just family planning specific or primary care providers as well? We will try to open up discussion tomorrow during section about your topic so we can all learn and think about this gap as a group.
Hey Sanithia,
Clinical care is definitely heading towards incorporating more shared decision-making, which I think makes your project very relevant.
While you've mentioned some interesting stuff to explore here, it seems that training providers to utilize these skills may be the largest hurdle to improving rates of shared decision-making. Do we know what provider knowledge is of shared decision-making and how many have undergone any formal type of training in SDM? Are there some providers (NPs for instance) that may do this better? Also, in evaluating clinic visits during which shared decision-making was utilized, do we know if there are actually differences in time spent on the clinic visit?
I look forward to hearing more about this in some of you subsequent work.
Asa