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Addressing potential pitfalls of reproductive life planning with patient-centered counseling - 14/11/16

Doi : 10.1016/j.ajog.2016.10.004 
Lisa S. Callegari, MD, MPH a, b, , Abigail R.A. Aiken, MD, MPH, PhD c, Christine Dehlendorf, MD, MS d, Patty Cason, MS, FNP-BC e, Sonya Borrero, MD, MS f, g
a Departments of Obstetrics and Gynecology and Health Services, University of Washington Schools of Medicine and Public Health, Seattle, WA 
b Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA 
c Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX 
d Departments of Family and Community Medicine, Obstetrics, Gynecology, and Reproductive Sciences, and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 
e School of Nursing, University of California Los Angeles, Los Angeles, CA 
f Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA 
g Center for Health Equity, Research, and Promotion, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 

Corresponding author: Lisa S. Callegari, MD, MPH.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 14 November 2016
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Abstract

Engaging women in discussions about reproductive goals in health care settings is increasingly recognized as an important public health strategy to reduce unintended pregnancy and improve pregnancy outcomes. “Reproductive life planning” has gained visibility as a framework for these discussions, endorsed by public health and professional organizations and integrated into practice guidelines. However, women’s health advocates and researchers have voiced the concern that aspects of the reproductive life planning framework may have the unintended consequence of alienating rather than empowering some women. This concern is based on evidence indicating that women may not hold clear intentions regarding pregnancy timing and may have complex feelings about achieving or avoiding pregnancy, which in turn may make defining a reproductive life plan challenging or less meaningful. We examine potential pitfalls of reproductive life planning counseling and, based on available evidence, offer suggestions for a patient-centered approach to counseling, including building open and trusting relationships with patients, asking open-ended questions, and prioritizing information delivery based on patient preferences. Research is needed to ensure that efforts to engage women in conversations about their reproductive goals are effective in both achieving public health objectives and empowering individual women to achieve the reproductive lives they desire.

Le texte complet de cet article est disponible en PDF.

Key words : family planning, One Key Question, PATH questions, patient-centered care, patient-centered counseling, preconception care, pregnancy planning, reproductive autonomy, reproductive goals counseling, reproductive life plan, reproductive life planning


Plan


 L.S.C. was supported by a Department of Veterans Affairs (VA) Health Services Research and Development Career Development award (14-412). A.R.A.A. was supported by an infrastructure grant for population research from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) (P2CHD047879). C.D. was supported by National Institute on Minority Health and Health Disparities of the NIH award number P60MD006902. S.B. was supported by 1R21HD076327-01A1 from the NICHD. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the VA.
 P.C. serves on advisory boards or as a consultant for Teva Pharmaceuticals (ParaGard), Allergan (Liletta), Medicines 360 (Liletta), Bayer AG (Mirena, Skyla, and intrauterine device in development), ContraMed (intrauterine device in development), and Evofem (spermicide in development). She is a trainer and speaker for Merck (Nexplanon, NuvaRing), Allergan (Liletta), and Medicines 360 (Liletta). The remaining authors report no conflicts of interest.


© 2016  Publié par Elsevier Masson SAS.
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