Impact of Shared Decision-Making on Contraception Continuation Rates

Abstract

Approximately fifty percent of all pregnancies in the United States are unintended each year. Reducing unintended pregnancy is a complex public health issue as identified in Healthy People 2020 with the goal of a ten percent reduction in unintended pregnancy by the year 2020. The misuse and/or early discontinuation of contraception is one of the most common contributing factors to unintended pregnancy. These facts led to the project question: Will the use of a standardized shared decision-making process for contraception selection improve contraception continuation rates? The goal of the project was to improve contraception continuation rates. A standardized contraception selection process including shared decision-making, the use of the My Contraception Tool decision aid, and provider-patient counseling with verbal and written information was implemented at a rural, tri-county health department. Retrospective chart analysis was performed to evaluate the improvement process and contraception continuation rates at the follow up visit. The sample included 29 eligible family planning patients. MCT was administered to 16 of the total sample (55.2%). Shared decision-making and provider-patient counseling was documented on 100% of the sample. 60% of the sample followed up for a method evaluation with a 58.8% contraception continuation rate. Medroxyprogesterone acetate and combined oral contraceptive pills were the most common contraceptive methods chosen. Patients that received MCT prior to seeing the provider were more likely to follow up for the method evaluation visit and to continue with contraception for pregnancy prevention.