Provider self-disclosure during contraceptive counseling

Abstract

Objective(s)-Provider self-disclosure (PSD) -defined as providers making statements regarding personal information to patients -has not been well-characterized in the context of contraceptive counseling. In this study we describe the incidence, content and context of contraceptive PSD.Study Design-This mixed methods analysis used data from the Provider-Patient Contraceptive Counseling study, for which 349 family planning patients were recruited from 2009 to 2012 from six clinics in the San Francisco Bay Area. Audio-recordings from their visits were analyzed for the presence or absence of PSD, and those visits with evidence of PSD were analyzed using qualitative methods. The associations of patient and provider demographics and patient satisfaction measures, obtained from survey data, with PSD were analyzed using bivariable and multivariable analyses.Results-37% of providers showed evidence of PSD during at least one visit, and PSD occurred in 9% of clinic visits. 54% of PSD statements were about intrauterine devices. About half of PSD statements occurred prior to the final selection of the contraceptive method and appeared to influence the choice of method. In post-visit surveys, all patients who reported receiving PSD considered it to be appropriate, and patient-reported PSD was not statistically associated with measures of patient satisfaction. Conclusion(s)-This study provides some support for the appropriateness of PSD during family planning encounters, at least as practiced during the sampled visits. Further research could explore whether this counseling strategy has an impact on patients' ability to identify the best contraceptive methods for them.

Contraceptive Counseling

“…This type of self-disclosure is a controversial topic in the health communication literature in general, as it can be seen, on one side, as enhancing the therapeutic relationship, or, alternatively, as a transgression of professional boundaries and an inappropriate distraction from the needs and experiences of the patient. Evidence from one study in family planning suggests that this type of disclosure is generally perceived to be appropriate by patients and contributes positively to the counseling dynamic, 42 which is consistent with patients’ desire for a closer personal connection with their provider in this context. The power of self-disclosure during contraceptive counseling is highlighted by a study that found that self-disclosure of IUD use increases uptake of this method.…”

Patient-Centered Contraceptive Counseling: Evidence to Inform Practice

“…Two qualitative studies about IUDs found that patients viewed provider selfdisclosure about IUD use positively, as it adds information about the experience of using a method, rather than medical information alone [28,30]. One quantitative study documented the potential influence of this type of communication, as it found a significant association between clinician selfdisclosure about IUD use and patients' choice of this method [32].…”