Patient-provider communication before and after implementation of the contraceptive decision support tool My Birth Control

Objective: To compare differences in patient-provider communication among patients who, prior to contraceptive counseling, used or did not use a decision support tool (My Birth Control) which has educational and interactive modules and produces a provider printout with the patient's preferences. Methods: As part of a cluster-randomized trial of the tool in four San Francisco safety net clinics, we collected and thematically analyzed 70 audio recordings of counseling visits (31 pre- and 39 post-tool implementation) from 15 providers randomized to the intervention. Results: Without the tool, most providers began by asking participants what method they were considering and focused counseling on that method or on directing patients towards long-acting reversible contraception; with the tool, most focused on reviewing and discussing multiple methods of interest to the participant as indicated on the printout. Discussion of patients' preferences for specific method features was not observed in pre-implementation recordings but was part of several post-implementation recordings. Several participants explicitly noted they had gained knowledge from the tool. Conclusion: Observed counseling differences suggest the tool may have a positive impact on patient-centeredness of contraceptive counseling, consistent with findings from the main study. Practice implications: My Birth Control shows potential for improving patient-centeredness in counseling without extensive provider training. (C) 2019 Elsevier B.V. All rights reserved.