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Latebreakers

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding

Perimenopause

Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

Find the “yes! . . . and” rather than “no” or “but”
January 2020

 

Shared decision-making sometimes has snags. You are, after all, the expert on the science. But your patients may believe misinformation they have been told, or may have misinterpreted in something they have read. When you find yourself feeling the need to correct your patient, or saying “that’s wrong/incorrect,” “no,” or “but,” consider instead the following strategy developed by Patty Cason and Abigail Aiken:[1]

  1. Find a kernel of truth in what they are saying (if there is one).
  2.  Acknowledge whatever correct information they have communicated.
  3. Then build on it by adding the information you would like them to know.

Rather than creating a polarizing situation with a “no” or a correction, it is preferable to build rapport and self-efficacy by finding something in what they are saying to agree with and then adding clarifying information.

Example: How to discuss amenorrhea from using contraceptives containing hormones:

Provider: Most people are very happy with their bleeding pattern when they use this method and many of them don’t get their period. How would it be for you if you didn’t get your period while you are using this method?

Patient: My mom said it’s not healthy not to get my period. (Note: at this point you may feel like correcting your patient.)

Provider: Your mother is completely right. When you are not on contraceptive hormones it is important to get your period . It’s so great that you know that if you miss your period when you are not on contraceptive hormones it could mean something’s wrong!  I wish all of my patients knew that if they are not on contraceptive hormones and they miss periods they need to come in to the clinic so we can see what’s up.

Patient: Well, what about if I am using hormones? (Note: People are more likely to be receptive to information if they have asked the question that the information answers.)

Provider: So . . . interestingly, when someone is using contraceptive hormones it keeps the uterus very healthy and keeps the lining very thin. (Show a diagram of a uterus.) Knowing that, how would it be for you to not get periods?

The provider could add the following message:

Provider: Contraceptive hormones actually prevent cancer of the uterus. Knowing that, how would it be for you not to get your period while using this method? Patients go online to find out about things they are interested in so your patient may have learned misinformation about contraception. Rather than correcting the misinformation, you can acknowledge that going on-line to seek information was proactive (i.e., point out the positive) and then share a good website like www.bedsider.org.

“But my friend…”

One of the most perplexing situations is when patients say that something bad happened to a friend or relative (or even to themselves) that you know is not possible scientifically. A strategy that has been shown to resonate with patients is to emphasize that “everyone is different.” This can readjust their frame of thinking to allow for the possibility that the (unscientific) “bad outcome” could be a chance occurrence.

A wonderful sentence to use in this situation might be as follows:

“That’s too bad your friend had that experience. I haven’t heard of that before, and I can tell you it definitely doesn’t happen frequently.”

Empathy

Central to patient-centered communication is the ability to exhibit empathy—verbally and non-verbally—by reflecting and validating a patient’s feelings. Empathy means communicating that one cares about another person’s feelings. You can demonstrate empathy by acknowledging feelings and communicating that someone’s reaction to a situation is normal and common to others in similar situations. Avoid some of the common communications that actually create barriers to effectively expressing empathy:

  • Underplaying (or overstating) the intensity of the emotion
  • Saying “I know how you feel” I
  • Incorrectly “labeling” someone’s feelings

Because each of us has different descriptions for each emotion, it is best not to “label” someone else’s feelings. This is particularly true with negative emotions like anger or anxiety. For example, labeling an emotion by saying “I can see that you are angry” at a time when the patient would have used the word “annoyed” to describe the feeling has the potential to damage rapport. It is possible to be truly empathetic in a more general way.  Here are some phrases to demonstrate empathy without labeling:

  • “I can see that was really concerning you.”
  • “It seems like that was hard to deal with!”
  • “I think anyone would find that situation very difficult to manage.”
  • “I can’t even imagine how that must have been for you.

Accomplishing reproductive goals counseling within a patient-centered framework can at times be challenging and take time. So take a deep breath and be the careful and caring clinician you are, knowing that shared decision-making safeguards reproductive rights and helps individuals make the best reproductive choices for themselves.

[1] Cason P, Aiken ARA. Pregnancy through patient-centred reproductive goals and contraceptive counseling. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018. http://contraceptivetechnology21st.com