Missed opportunities in contraceptive counselling: findings from a European survey-based study with simulated patient consultation

Purpose: Available evidence highlights unmet needs in contraceptive counselling practices. This study aimed to understand current practises and clinician behaviour across Europe. Methods: A novel, online approach was used to simulate contraceptive counselling discussions based on three, predefined patient types with a hidden need: poor compliance (patient X), headaches (Y) or desire for a hormone-free option (Z). Clinicians were asked to provide guidance about a contraceptive method for their randomly assigned patient at two time points: (1) after a simulated discussion, (2) after seeing a full patient profile. Descriptive statistical analyses included evaluation of the clinicians’ counselling approach and a change in contraceptive recommendation thereof. Results: Out of 661 clinicians from 10 participating European countries, including obstetricians/gynaecologists, midwives and general practitioners, most failed to uncover patient X and Y’s hidden needs (78.8% and 70.5%, respectively), whereas, 63.4% of clinicians uncovered patient Z’s hidden need. Clinicians who uncovered their patients’ hidden needs asked significantly more questions than those who did not (range of mean, 5.1–7.8 vs 1.5–2.2 respectively). Clinicians were more likely to recommend a change of prescription after seeing the full patient profile than after the simulated discussion (increase in prescription change, range: 12.3–30.2%), indicating that clinicians rely on patients speaking up proactively about any concerns. Conclusions: Insufficient existing counselling practices result in missed opportunities for shared decision-making and discussion. Clinicians and contraceptive counselling services should empower women by introducing more in-depth contraceptive counselling, incorporating clear, open-ended questions, to improve patient adherence and enhance reproductive planning.