Best Questions
A very effective question may be:
“Can you tell me something that’s important to you about your birth control?”
--or--
"Can you tell me something you're looking for in your contraception?"
--or--
“Do you have a sense of what is important to you about your birth control method?”
It may take time for someone to think about the question. If the patient does not immediately respond, give them time (5 seconds) to consider what they think is important to them.
If the patient asks, “what do you mean?,” you can give examples based on what you know about them:
“For example, some methods are easier to hide than others.”
--or--
“For example, some methods change the way your periods come and others don’t. Is that something that is important to you?”
--or--
“For example, there are things other than preventing pregnancy that some types of birth control can do for you like... [give an example that may be relevant to the person] treating acne, or letting you skip your period, or preventing some types of cancer.”
Once the patient tells you something that is important to them, you can reflect that you heard them and then ask, “Can you tell me what else might be important to you?" or “what else are you looking for?”
It may be helpful to ask further probing questions about what they have said, and about the various attributes listed here:
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ability to conceal: It is important to determine in what way they need the method concealed; is a parent or partner monitoring their menses? Is it challenging to store supplies (condoms, pills etc.)?
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frequency of use
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effect on the menstrual cycle/bleeding profile (changes the way your period comes)
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side effects
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non-contraceptive benefits
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return to fertility: for all methods except DMPA, “Once you stop using ___ your ability to get pregnant goes back to whatever is normal for you immediately!”
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preferences regarding hormones; however, once you know what characteristics are important to them and you offer a method consistent with those preferences, if you offer a hormonal method the person will have an opportunity to respond
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impact on sexual life
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control over removal: for IUD and implant—however it is critically important that we ensure that all patients have unfettered access to removal whenever they request it.
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effectiveness: you will already have a sense of this from their reply to, “How important is it to you to prevent pregnancy?”
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length of use: this does not generally need to be a factor; any method can be used for any length of time; short acting methods can be used for decades; implants and IUDS are good for “up to” 3-12 years but can be used for any length of time “up to” their expiration; if a patient wants to use a device beyond the effective length of use, they can have it replaced
Once you begin to get a sense of what their priorities are for method characteristics, you can offer options based on their stated preferences.
Refer to the use ASA cycles, or think in terms of the following: ask, tell, ask.
Whenever you give a piece of information, follow it with one of these sorts of questions:
"How would that be for you?"
"Knowing that, what do you think?"
"How would you manage that?"
"How have you managed it?"
"Has that happened to you in the past?
Example: "Many people who use this IUD do not get their period while they are using it. How would it be for you if you didn't get your period while you are using the IUD?"
A not-as-good question would be:
“What birth-control method would you like?”
Asking about contraceptive preferences in this way may:
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close down further discussion because it takes the conversation directly from: “I was thinking about the pill” to “OK, here’s a prescription."
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risk making the patient feel like they “should” have an answer
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not encourage the patient to explore their options based on their preferences for method characteristics or allow for guidance about various attributes of different methods that matter to the person.
