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Randomized clinical trial of a computerized contraceptive decision aid

Colleen McNicholas, Washington University in St. Louis School of Medicine, 2011

Project abstract

Unintended pregnancy continues to be a significant public health problem in the United States despite widespread use of contraception. Contraceptive counseling is an important mediator of contraceptive selection and use, but there is little data to indicate what constitutes effective contraceptive counseling. An intervention which improves patient education and counseling has the potential to improve contraceptive use.

Patient decision aids have been successfully employed in other areas of healthcare decision making and have been shown to result in increased knowledge, more realistic expectations, and decreased decisional conflict. In this study, we propose to conduct a randomized clinical trial of a web-based contraceptive decision aid compared to routine contraceptive counseling to evaluate the effect of the contraceptive decision aid on the contraceptive method selected by the participant.

Our secondary aims are:

  1. to measure decisional conflict pre- and post-intervention using the validated Decisional Conflict Scale and compare the change in decisional conflict score in women randomized to the contraceptive decision aid to women undergoing routine counseling, and
  2. evaluate satisfaction with contraceptive counseling and contraceptive continuation and satisfaction at 3 and 6 months.

This project is novel in its focus on a web-based contraceptive decision aid which incorporates women’s values and preferences in contraceptive decision making. Additionally, the decision aid will incorporate an algorithm which will recommend contraceptive methods based on these values and preferences.

Our primary outcome will be to compare uptake of highly effective contraception; however, we will also evaluate the outcome of decisional conflict which has been used in multiple clinical trials of patient decision aids to measure the effectiveness of decision aids.

If successful, this intervention will improve contraceptive use by improving contraceptive knowledge, satisfaction with contraceptive method chosen, and decreasing decisional conflict. This has the potential to reduce the rates of unintended pregnancy.

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