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Helping Your Patients Decide: Making Informed Health Choices About Hormonal Contraception

(Published June 2006)

Considerations for Risk Communication About Hormonal Contraceptives

You’re in an exam room with a patient. She wants to switch contraceptive methods. What should you tell her about associated risks? How should you tell her? What, exactly, should you say and do?

There are four aspects to communicating with patients about the risks associated with contraceptives: patient needs and concerns; relevant

"Two times a very rare event is still a very rare event."
- David Grimes, MD, March 2006
factors to consider; tools to use; and guidance. The latter two topics are addressed in subsequent chapters.

Patient Needs and Concerns: What to Ask

Before beginning a discussion about hormonal contraception, providers should understand the woman’s needs and concerns so they can tailor their discussion appropriately. To gather this information, providers should weave many of the following questions into their dialogue:

  • How important is it for you to avoid pregnancy right now?
  • How long do you want to prevent pregnancy (with this method)?
  • Do you want your use of contraception to be private?
  • Are you comfortable inserting a contraceptive into your vagina?
  • Do you have concerns about a particular contraceptive method? (e.g., media reports, friend’s experience)
  • What side effects (or risk of serious problems) are you willing to accept?

It’s also important to gather information about factors such as age, relationship status, smoking status, history of a bleeding or clotting disorder, and involvement in higher-risk sexual behavior. The presence of these risk factors may affect the risk/benefit ratio for a particular contraceptive.

Relevant Factors: What to Consider

When communicating about risk, providers should consider a number of relevant factors, which have been described previously. Providers need to remember that the woman’s level of trust in the provider of information will affect her perception of the risk. The presentation of the risk—especially framing effects—also will affect risk perception, as will cultural, literacy, and developmental factors (see Factors Affecting the Perception and Interpretation of Risk). Providers must remember that risk is not strictly an intellectual issue and therefore cannot be effectively addressed solely by providing additional or more accurate numerical data. Finally, providers eed to be wary of using risk comparisons that include dissimilar risks, because such comparisons may offend, confuse, or alienate some patients.