Evaluation of a fertility awareness-based shared decision-making tool part 2:  Patient experiences

Marguerite Duane; Virginia Martinez; Meghan Berry; Sarah Gilpatrick; Michael D Manhart

doi:10.1016/j.pecinn.2023.100169

Ethics and Policy Informed Consent

Evaluation of a fertility awareness-based shared decision-making tool part 2: Patient experiences

Duane M, Martinez V, Berry M, Gilpatrick S, Manhart MD

Published December 2023 PEC Innovation, 2, 100169

DOI 10.1016/j.pecinn.2023.100169 PMID 37384150 PMC PMC10294094

RRM Academy Synopsis

Decision tool raised fertility awareness-based method use at 6 months

Patients seen with the tool more often started or changed a method by six months. The decision-making tool for fertility awareness-based methods was tested in a prospective crossover study with 26 clinicians. Among patients followed up, 52 out of 100 in the tool period had started or changed a method, against 36 out of 100 under usual practice.

Key Findings

Among patients with six-month follow-up, 52% (34/66) in the experimental group had started or changed a fertility awareness-based method (FABM), versus 36% (24/66) in the control group (p = 0.04).
Immediately after the office visit, the groups did not differ significantly in likelihood of changing family planning methods, at 48% (control) and 52% (experimental) (p = 0.48).
Among patients who changed FABMs, excluding those new to FABMs, 50% in the experimental group reported increased satisfaction versus 17% in the control group (p = 0.022).
Among patients who started or changed a method and rated satisfaction, 45% in the experimental group and 35% in the control group reported increased satisfaction (p = 0.22).
Among patients new to FABMs, 60% (12 of 20) in the experimental group chose a method other than mucus-only, versus 22% (2 of 9) in the control group (p = 0.03).

Interpretation

This prospective crossover study compared a control period of usual office visits with an experimental period in which 26 clinicians used the tool. Eligible patients were aged 18 to 44 and had recently started a family planning method or were considering starting, changing or restarting a fertility awareness-based method. They completed surveys before and after the visit and online at six months, and 66 per group provided the six-month survey. The authors note that the clinicians were highly knowledgeable about these methods and the patient population had a high rate of use. The authors suggest testing the tool with clinicians less knowledgeable about the methods.

RRM Context

Restorative reproductive medicine builds on body literacy, the ability to read one's own cycle signs. Cervical fluid and basal body temperature help show the fertile window. Study patients chose among methods such as Creighton, Billings and Marquette.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To assess patient experiences using a Shared Decision-Making (SDM) Tool for fertility awareness-based methods (FABMs) of family planning.

Methods

The study employed a prospective crossover design to evaluate impact of the SDM tool compared to usual practice when discussing FABMs with patients. Patients completed pre- and post-office visit surveys and an online survey six months later. The primary outcomes evaluated the effect of the SDM tool on patient satisfaction and FABM continuity of use rates.

Results

There was no significant difference in likelihood of changing family planning methods immediately after the office visit; however, by six months a significantly larger proportion of patients had started or changed FABMs in the experimental group (52%, 34/66) compared to the control group (36%, 24/66) (p = 0.04). Significantly more patients who used the tool and changed their FABM after their visit reported increased satisfaction with their FABM compared to control (50% vs. 17%, p = 0.022).

Conclusions

Use of the SDM tool increased persistent use of and satisfaction with chosen FABMs at six months.

Innovation

The novel SDM tool can enhance patients' understanding and facilitate the selection of a more suitable method leading to increased satisfaction.

Topics

Ethics and Policy › Informed Consent › Decision Making Support · Contraception › Comparative Studies › Contraception Versus Fertility Awareness · Fertility Awareness › Use and Experience › Shared Decision Making

Marguerite Duane, Virginia Martinez, Meghan Berry, Sarah Gilpatrick, Michael D Manhart

M Duane, V Martinez, M Berry, S Gilpatrick, Mike Manhart, M Manhart

PMID 37384150 37384150 DOI 10.1016/j.pecinn.2023.100169 10.1016/j.pecinn.2023.100169 Duane et al. 2023, Duane 2023