Does structured counselling influence combined hormonal contraceptive choice?

ABSTRACT

Objective To assess the effect of structured counselling on women's contraceptive decisions and to evaluate gynaecologists’ perceptions of comprehensive contraceptive counselling.

Methods Belgian women (18–40 years old) who were considering using a combined hormonal contraceptive (CHC) were counselled by their gynaecologists about available CHCs (combined oral contraceptive [COC], transdermal patch, vaginal ring), using a comprehensive leaflet. Patients and gynaecologists completed questionnaires that gathered information on the woman's pre- and post-counselling contraceptive choice, her perceptions, and the reasons behind her post-counselling decision.

Results The gynaecologists (N = 121) enrolled 1801 eligible women. Nearly all women (94%) were able to choose a method after counselling (53%, 5%, and 27% chose the COC, the patch, and the ring, respectively). Counselling made many women (39%) select a different method: patch use increased from 3% to 5% (p < 0.0001); ring use tripled (from 9% to 27%, p < 0.0001). Women who were undecided before counselling most often opted for the method their gynaecologist recommended, irrespective of counselling.

Conclusion Counselling allows most women to select a contraceptive method; a sizeable proportion of them decide on a method different from the one they initially had in mind. Gynaecologists’ preferences influenced the contraceptive choices of women who were initially undecided regarding the method to use.

Keywords:

• Combined hormonal contraception
• Combined oral contraceptives
• Transdermal patch
• Vaginal contraceptive ring
• Counselling

ACKNOWLEDGEMENTS

We wish to express our gratitude to all participating women and gynaecologists. The CHOICE study was designed by an international expert committee (including SW) and MSD; it was also endorsed by the European Society of Contraception and Reproductive Health (ESC). It was adapted for the Belgian CHOICE study by the authors of this manuscript, who also oversaw the study in Belgium. A. P. Morello III, PhD, of Evidence Scientific Solutions, Philadelphia, PA, provided editorial assistance but did not meet all ICMJE criteria for authorship. The statistical analyses were performed by biostatisticians at MSD, Oss, The Netherlands.

Declaration of interest: T. Van de Sande is employed by MSD, Belgium. The four other authors report participation in expert meetings organised by MSD Belgium and receiving honoraria for consultancy and lectures from MSD Belgium. Although the study was funded by MSD, the authors alone are responsible for oversight of the study and the content and the writing of the paper.