Effectiveness of a Patient Decision Aid in Immediate Postpartum Contraceptive Counseling
Effectiveness of a Patient Decision Aid in Immediate Postpartum Contraceptive Counseling
Effective physician-patient communication in postpartum contraceptive counseling is essential
 for patients to meet their contraceptive needs and reduce the risk of rapid repeat
 pregnancies. This project will utilize a patient decision aid to facilitate shared decision
 making in the immediate postpartum setting, assess the effectiveness of such aid in "decision
 quality" and "decision-making process quality", and observe its effects on contraceptive
 choice mix at the time of discharge.
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