Interactive feature finds patients’ priorities
By Melinda Young
Providers and patients who would like a little help in contraceptive counseling and decision-making could use a new tool — a digital contraceptive decision aid — that could enhance women’s confidence and satisfaction with their contraceptive recommendation, new research shows.1
The decision aid can be used in doctors’ offices through a link to an app that patients can download. The aid educates people about contraceptives and symptoms. Its interactive feature asks patients to answer questions about the things that are most important to them. These could include side effects that are associated with hormonal birth control use, says Sarah E. Hill, PhD, professor, department of psychology, at Texas Christian University in Fort Worth.
“The aid asks them about their own experiences, what their values are, and what they would like to use in hormonal contraception,” she explains. “What are they looking for? What is the most important thing they’d like?”
If a patient answers that they struggle with premenstrual syndrome (PMS), then the decision aid will ask them what is most important to them and what they would desire in a contraceptive. Then, the patient could say they would like to get rid of their PMS.
“That way, patients have a say in what they value and want in their birth control,” Hill says. “The decision aid has a database and uses AI to learn about different birth control and their side effects, and it matches women to the type of birth control that would meet their contraceptive needs and are aligned with their life goals.”
The aid avoids recommending contraceptives with side effects that the patient has said are not acceptable to them.
OB/GYNs and other physicians using the decision aid will receive different options as well as a health report the aid generates. It provides information about the patient, giving doctors a snapshot of what their contraceptive goals are, and it gives them the tool’s recommendations for the patient, Hill says.
“It gives information to the doctor, who can read the report and make their own decision about which contraceptives to recommend,” she adds. “Do they pick one that is based on their own knowledge base?”
Research on the decision aid has found that physicians like it. Their response is positive, and they largely agree with its recommendations, Hill says.
“New products are considered, and as physicians learn more, they understand and agree this is a great idea for this patient,” she adds. “This saves time at the appointment but also offers more personalized experience for the users.”
Patients also like the aid because they feel seen and heard. Using the tool is meant to be helpful but not to replace patients’ personal decisions. If they disagree with the option recommended, they can try the contraceptive they want.
“If there’s not any medical reason not to recommend that contraceptive to that woman, then the doctor would let her try it,” Hill says. “It’s patient-centered care with individualized birth control recommendations based on a woman’s hormonal symptoms and values.”
The goal is to assist physicians with contraceptive recommendations without being a burden on the healthcare system. The tool does not increase physician and health clinic time spent on contraceptive counseling, she notes.
It is not intended to replace a provider’s contraceptive counseling.
“Patients want a human being to help them, and this offers a nice bridge to get individualized experiences with your doctor, who is weighing in on it,” she says.
“In our paper, we were interested in the user side of things, the patient’s side. We were interested in comparing use of the decision aid to a more traditional contraceptive appointment,” Hill explains. “We wanted to see if using [the decision aid] decreased women’s decision conflict: Do they feel less conflicted about whether they want to use this or not use it? Do they expect things will go well, and do they like their contraception?”
Other questions are:
- Do they feel seen and heard?
- Are they satisfied with the recommendations they receive?
- How positive and happy are they about starting the contraceptive?
“We were interested in the patient’s side of things in this particular project, and we have another paper that is looking at the decision aid and reproductive health efficacy and hormonal symptoms,” Hill explains. “This aid — in addition to making women more likely to start hormonal birth control and more positive about it — has recommendations specifically for them, based on their needs and values and their own hormonal struggles.”
Women feel good about having this kind of patient-centered attention. Physicians also gave positive feedback about how the tool fit in with their time goals in providing contraceptive counseling, she adds.
The tool is beneficial from a reproductive justice standpoint because it helps reduce provider bias and stereotypes when making contraceptive recommendations, Hill says.
“I hope to see some day that this type of product — even if not this one, which I really like — is available at clinics that serve populations of women who do not always get personalized medical care and that a tool like this can create a patient-centered experience for every patient,” she says. “This is the closest thing we have to offering an individualized medicine approach to birth control for women that doesn’t require doctors to make longer appointments,” Hill says.
Providers who are not OB/GYNs but who also provide contraceptive care, such as general practitioners and pediatricians, could use this tool to help them with contraceptive counseling and improve recommendations for their patients.
“People expect doctors to know everything, but there are over 100 different hormonal contraceptives out there,” she explains. “Women’s bodies are all very different from one another, and I would like to emphasize there is no stigma in having something like this help you out.”
If using a contraceptive decision aid helps a provider or clinic reduce the number of visits it takes for a woman to obtain the contraception of her choice, then that is reducing barriers.
“It takes the onus off general practitioners and helps to narrow down the contraceptive options, using expertise to make recommendations of products that are the most positive for their patients,” Hill says. ”My guess is we’d have women less likely to switch contraceptive methods if they have birth control recommended to them in this way, and we may not get as many women writing off all birth control because of their first horrible experiences with side effects.”
REFERENCE
- Espinosa M, Butler SA, Mengelkoch S, et al. The impact of a digital contraceptive decision aid on user outcomes: Results of an experimental, clinical trial. Ann Behav Med 2024;58:463-473.
