共同决策:产后避孕咨询的前进之路。

IF 1.8 Q3 OBSTETRICS & GYNECOLOGY Open access journal of contraception Pub Date : 2022-01-01 DOI:10.2147/OAJC.S360833
Brooke W Bullington, Asha Sata, Kavita Shah Arora
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引用次数: 4

摘要

有多层障碍影响产后避孕的接受并导致差异,包括临床障碍,如提供者偏见。幸运的是,临床医生可以直接控制他们的避孕咨询实践,因此通过高质量的避孕咨询,为患者提供满足生殖欲望所需的知识和指导,减少结构性障碍是可行的。然而,许多常用的避孕咨询策略,如“一个关键问题”和世卫组织分层避孕咨询,不是以患者为导向的,没有考虑到避孕选择的重要细微差别,也没有专门关注产后时期。鉴于优生学和生殖强迫在美国的历史,支持患者通过他们的避孕决策过程是特别重要的。此外,避孕偏好因患者水平因素而异,随时间而波动,咨询应考虑到这种差异。当患者就其价值观、愿望和偏好提供意见,而临床医生在不加评判的情况下分享医学知识和循证信息时,就会发生共同的避孕决策。这种方法被认为是最合乎道德的咨询形式,因为它最大限度地提高了患者的自主权。共同决策也有临床益处,包括提高患者满意度。总之,应普遍采用共同的避孕决策,以促进伦理、高质量的护理和生殖自主。
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Shared Decision-Making: The Way Forward for Postpartum Contraceptive Counseling.

There are multi-level barriers that impact uptake of postpartum contraception and result in disparities, including clinical barriers such as provider bias. Fortunately, clinicians have direct control over their contraceptive counseling practices, and thus reducing structural barriers is actionable through high quality contraceptive counseling that equips patients with the knowledge and guidance they need to fulfill their reproductive desires. Yet, many commonly employed contraceptive counseling strategies, like One Key Question and WHO tiered contraceptive counseling, are not patient-driven, do not account for the important nuances of contraceptive choices, and are not focused specifically on the postpartum period. Given the history of eugenics and reproductive coercion in the US, supporting patient through their contraceptive decision-making process is especially vital. Additionally, contraceptive preferences vary based on patient-level factors and fluctuate over time and counseling should account for such differences. Shared contraceptive decision-making occurs when patients provide input on their values, desires, and preferences and clinicians share medical knowledge and evidence-based information without judgement. This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction. In sum, shared contraceptive decision-making should be universally adopted to promote ethical, high-quality care and reproductive autonomy.

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