My Decision/Mi Decisión, a web-based decision aid for permanent contraception decision-making, can be used in a variety of settings, including family planning clinics, health departments, hospitals, and OB/GYN offices.
“We are currently working with different organizations to implement My Decision broadly,” says Elizabeth A. Mosley, PhD, MPH, an assistant professor of medicine at the University of Pittsburgh Center for Innovative Research on Gender Health Equity. “We recently tested the decision aid in a randomized controlled trial with 350 pregnant people. We learned that the decision aid significantly and meaningfully increases people’s knowledge about tubal sterilization, and it reduces the decisional conflict they feel about their contraceptive decision.”
Mosley describes how the tool works:
• Mode of delivery. The tool can be used via tablets in a medical office. Patients also can access it on their own computer or tablet at home.
“We are also in discussion with some groups about how My Decision could be integrated into electronic medical record systems so patients can complete the decision aid privately on their patient portal,” Mosley says. “They could then share information with their provider if they choose.”
The tool’s access could be broadened to the public. “We believe this tool could be made open to the public so people who are considering tubal sterilization can use it without having to go through a healthcare provider,” Mosley explains. “Finally, we see potential for this decision aid to be used to improve the current Medicaid consent process required for Medicaid recipients who want tubal sterilization. Perhaps, in the future, decision aids like this one can be used to ensure people are making informed and values-concordant decisions free of coercion, but also free of impediments that reduce access to contraceptive care.”
• Focus on patient-centered care. “It’s a tool that is very patient-centered, and we’re envisioning it being delivered through the healthcare setting with clinicians recommending their patients use the tool,” Mosley says. “It might also be publicly accessible and available outside of the health setting.”
The web-based aid features color illustrations of the uterus and fallopian tubes. It shows what happens with tubal ligation and salpingectomy. One diagram shows where the tubes are cut or clipped or burned or banded in four illustration boxes.1
People can click on any of the contraceptive methods listed in another chart, and they can learn more about that method and how it compares to sterilization. The comparisons include effectiveness, whether it contains hormones, ease of use, and discretion.
In the fourth section, called “Take Time to Reflect,” users can go through a series of personal reflections about how they think about tubal sterilization and what their values are. It also discusses their ideal support system for making this decision.
“This tool helps them think through the decision,” Mosley says. “Anyone could benefit from this.”
• User experience. “To use it, an interested patient opens the decision aid through a web browser on their computer, phone, or tablet,” Mosley says. “The first section introduces the user to the decision aid. Secondly, it provides two educational videos: One about how pregnancy works, and the other about how tubal sterilization surgery works.”
In the third section, the user is taken through an interactive exercise to compare different contraceptive methods.
“In the fourth section, the user is guided through a series of prompts, and they take time to reflect on factors like their family situation, life circumstances, and health factors,” Mosley explains. “Then, users are guided through a decisional clarity exercise where they consider their level of knowledge, their values, the support they have, and how certain they feel about their decision around tubal sterilization.”
They can choose to explore one of several situational factors from a checklist. These include their family situation, relationship factors, personal goals, life circumstances, and health factors. They are encouraged to rank those reasons for the permanent contraception decision.
“Finally, the user is given a summary report of all their answers, which they can choose to share with their healthcare provider,” Mosley says. “Throughout the decision aid, users can click on terms for their definitions, take notes about their thoughts and feelings, and click on frequently asked questions for clarification.”
• Decision aid creation. “This paper is an explanation of how this decision aid was developed,” Mosley says. “We wanted to give people a roadmap for how to design a patient-centered aid for clinical care that was stakeholder-engaged.”
The paper gives snapshots of how the decision aid looks, the content, and its basic education about pregnancy and sterilization surgery. Similar decision aids could be developed for all forms of contraception, including vasectomy.
Decision aids can be an add-on service physicians provide to patients. They can recommend it to patients, who can use it as they like. “We’re looking at opportunities to partner with large healthcare systems to implement the tool,” Mosley explains. “It could be for patients who are pregnant and receiving counseling for postpartum contraception.”
This decision aid’s focus on sterilization has drawn more interest since Roe v. Wade was overturned. “We were anecdotally seeing an increase of interest in our study,” Mosley says. “Researchers were hearing from people who were interested now because abortion was being restricted.”
REFERENCE
- Mosley EA, Zite N, Dehlendorf C, et al. Development of My Decision/Mi Decisión, a web-based decision aid to support permanent contraception decision making. PEC Innov 2023;3:100203.
My Decision/Mi Decisión, a web-based decision aid for permanent contraception decision-making, can be used in a variety of settings, including family planning clinics, health departments, hospitals, and OB/GYN offices.
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