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What is patient-centered contraceptive counseling?

What providers need to know about patient-centered contraceptive counseling and how to put it into practice.

by Robin Watkins, CNM, WHNP-BC

published 01/17/24

When it comes to contraceptive counseling, patient-centered contraceptive counseling is key in ensuring that patients feel respected and heard while talking about birth control with their provider. Shared decision-making is a model of health communication that is well-suited to high-quality patient-centered contraceptive counseling. In shared decision-making, the health care provider contributes their medical knowledge to the interaction, while the patient provides expertise on their own values and preferences. By collaborating, the provider and patient can achieve their shared goal of the patient making a decision that is most consistent with their contraceptive preferences.

Building rapport

Having good rapport is a foundational component of patient-centered contraceptive counseling and taking the time to build rapport with your patients has a lasting impact. There are lots of ethical arguments for why providers should offer high-quality, patient-centered counseling to our patients, but research offers concrete evidence that the quality of birth control counseling matters for our patients. Research shows that patients who reported that their provider respected them, took their preferences seriously, gave them personalized information, and answered all their questions were more likely to be using their chosen birth control method six months later. Continuing to use a method of birth control suggests that these patients had found a method that was working for them, which can be a long journey.

Respectful, personalized, and patient-centered birth control counseling sets a foundation for our patients to find the method that works best for them. When our patients trust us as providers and view counseling experiences positively, they may be more likely to return to us for care—for birth control or any other highly personal issue. In the end, having a respectful relationship and paying careful attention to the dynamics between you and your patient has bigger implications than just being a “gold standard” for care. It has the potential to empower your patients to achieve reproductive well-being.

Reflectively listen and be non-directive

Reflective listening involves paying careful attention to what a patient is saying and letting them know that they have been heard and understood. It generally includes reflecting back to the patient the thoughts and feelings you heard through their words, tone of voice, and even their body posture, and gestures. Making eye contact while patients are talking makes it clear that you are listening.

Being non-directive means letting the patient set the tone and direction of the conversation while you follow. For example, if the patient asks a question about a particular birth control method, you can answer that question without bringing up other methods that you may think they should consider. Remember, there is no “best” method of birth control for everyone. Rather, the best method for each person depends on their unique needs and preferences, which can change over time, and may include no method at all.

Offer resources

In order to make informed decisions, patients need information that is accurate and non-judgmental. When speaking with patients or providing educational materials, present information in a manner that can be easily understood and absorbed by the patient. Providers can connect patients interested in learning more about birth control with or using Bedsider educational materials to patients can support patient-centered, non-directive contraceptive counseling.

Confirm understanding

At the end of a patient-centered contraceptive counseling session, you should confirm:

  • The patient’s individualized goals;
  • The patient’s understanding of action steps;
  • Any recommended referrals; and
  • That the patient’s questions are answered to the best of your ability.

Having patients restate the most important messages in their own words helps patients process the information you provide. This can also increase the likelihood that a patient and provider reach a shared understanding.

Putting patient-centered contraceptive counseling into practice

Growing and improving in any skilled activity requires two things: practice and feedback. It’s not just about putting in the time, but also having a way to evaluate one’s performance through feedback. That can be scary, but if you have access to it, consider having a colleague observe some of your patient interactions. Another approach is to pay closer attention to how patients respond to you. How much personal information do they share? Do they ask difficult questions? When you respond to a difficult question, what shifts do you notice in their posture, the tone of their voice, or their language? Use those observations to inform and adjust your approach.

Robin Watkins is the Director of Clinical Affairs and Medical Education at the Society of Family Planning. Robin is a midwife and women’s health nurse practitioner focused on expanding provider capacity to offer just, equitable, resonant, and high-quality sexual and reproductive health care. Robin provides clinical care in the Washington, DC area. When she is not talking sex or placing IUDs, you can find her riding her bike on the streets of DC or eating ice cream for dinner.
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