Shared Medical Decision Making

Shared medical decision making

Shared medical decision making is a process in which the obstetrician–gynecologist or other health care provider shares with the patient all relevant risk and benefit information on all treatment alternatives and the patient shares with the obstetrician–gynecologist or other health care provider all relevant personal information that might make one treatment or side effect more or less tolerable than others.

It can increase patient engagement and reduce risk resulting in improved outcomes, satisfaction, and treatment adherence.

Decision making is a continuum with the obstetrician–gynecologist or other health care provider leading the discussion on one end, and with patients making the decision on the other end. Although medical knowledge is tipped toward the obstetrician–gynecologist or other health care provider end of the continuum, in shared medical decision making, a middle ground is sought that incorporates sound medical care and a patient’s personal preferences.

Patient-centered goals should also be considered in the decision-making process. However, providers should share their clinical judgment on best choices when they believe a clear benefit exists.

Supporting Patient Autonomy

The U.S. has a history of coercive provision of contraception and forced sterilization. Due to this history, marginalized communities may mistrust clinicians and the broader health care system. Any counseling about postpartum contraception, especially sterilization or LARC, should be sensitive to this history. LARC can give women a decreased sense of control over their contraception, as a clinician is required for both device initiation and removal.

Health care provider bias can contribute to coercion, and health care providers are encouraged to self-reflect on their own biases and how to provide patient-centered care that supports autonomous decision-making.

ACOG supports the LARC Statement of Principles by SisterSong and the National Women’s Health Network (NWHN).

The LARC Statement of Principles says, “We believe that people can and do make good decisions about the risks and benefits of drugs and medical devices when they have good information and supportive health care. We strongly support the inclusion of long-acting reversible contraceptive methods (LARCs) as part of a well-balanced mix of options, including barrier methods, oral contraceptives, and other alternatives. We reject efforts to direct women toward any particular method and caution providers and public health officials against making assumptions based on race, ethnicity, age, ability, economic status, sexual orientation, or gender identity and expression. People should be given complete information and be supported in making the best decision for their health and other unique circumstances.”

More information about the statement can be found on the NWHN’s page about LARC.

ACOG also supports the use of a reproductive justice framework for contraceptive counseling, which is essential to providing equitable health care, accessing and having coverage for contraceptive methods, and resisting potential coercion by health care providers.

Citation:

Citation: Dehlendorf C, Levy K, Kelley A, Grumbach K, Steinauer J. Women’s preferences for contraceptive counseling and decision making. Contraception 2013;88:250-6.