Effectiveness of a Patient Decision Aid in Immediate Postpartum Contraceptive Counseling

More than 51% of pregnancies in the US are unintentional. Of the unintended pregnancies, 43%
are attributable to incorrect or inconsistent use of contraceptive methods. Gaps in
contraceptive use can arise from a misalignment of the patient's needs or preferences and her
chosen method. This is particularly salient in the postpartum setting; nearly two-thirds of
women in their first year of postpartum have unmet need for family planning, and adolescents
in particular are at high risk for repeat pregnancies within a year.

Effective physician-patient communication in postpartum contraceptive counseling is essential
for patients to meet their contraceptive needs. Previously, there has been an emphasis on
"informed choice" model for counseling, in which the clinician's role is to provide
information to the patient in order to facilitate her choice of a contraceptive method. The
provider does not actively participate in the process of selecting the method, in the spirit
of respecting patient autonomy. Dehlendorf et al. has shown that while women do value
autonomy in making a decision about their contraceptive method, they prefer more provider
involvement in the decision making process than the "informed choice" model allows. This has
given room for a rise in interest in Shared Decision Making (SDM) model of counseling for
contraceptive care. In the SDM model, the clinical plays a supportive role in patient
decision making, by not only providing information but also guiding the patient through her
deliberation. While the final decision is left in the hands of the patient, they are given
support to identify their preferences and needs, and to align them with an option that best
matches her preferences and needs.

Various decision making tools have been developed to facilitate SDM. One method is to display
all available options in one axis, and frequently-asked questions regarding each option in
the other axis. Patients are asked to select frequently-asked questions that address their
concerns, thereby sorting through the most pertinent information regarding their options in
one view. Research has shown that such patient decision aids (PtDA) help patients understand
their options, feel more informed, participate in decision making, and have more accurate
expectations of possible outcomes.

The goal of this project is to utilize a PtDA to facilitate SDM in the immediate postpartum
setting, assess the effectiveness of such PtDA on decision quality and decision-making
process quality (as defined and measured by previously validated survey tools), and to
observe its effects on patients' contraceptive choice at the time of discharge.

Inclusion Criteria:

- Fluent English or Spanish speaking

- Delivered during current admission to hospital

- Postpartum day 1 or post-op day 1 or 2

Exclusion Criteria:

- Females less than 14 years of age

- Status post sterilization or hysterectomy

- Received an intrauterine device immediately after delivery (postplacental)

- Does not have a smartphone capable of browsing the internet