Missed Opportunities in Contraceptive Counselling: Findings from a European Survey-based Study with Simulated Patient Consultation

Background: Available evidence highlights unmet needs in contraceptive counselling practices. The aim of this study was to better understand current practices and clinician behaviour across Europe.Methods: This survey-based study used a novel, online approach to simulate contraceptive counselling discussions based on three, predefined patient types, each with a hidden need. Clinicians were asked to recommend a contraceptive method for their randomly assigned patient at two time points: 1) after a simulated discussion, during which they were given a brief patient profile and the opportunity to question their patient to obtain further information; 2) after they had been presented with a full patient profile. Descriptive statistics were used to analyse the clinicians’ counselling approach, how successful clinicians were at uncovering the hidden needs of their patients, and whether an understanding of these needs would cause clinicians to change their contraceptive recommendation. Results: In total, 661 clinicians from 10 European countries participated in the study, including obstetricians/gynaecologists, midwives and general practitioners. Clinician specialty varied by nation. Most clinicians (78.8% and 70.5%, respectively) failed to uncover the hidden needs of patients X and Y, both of whom had requested prescription renewals. By contrast, 63.4% of clinicians uncovered the hidden need of patient Z, who had requested a review of her contraceptive method. Clinicians who did uncover their patients’ hidden needs asked significantly more questions than those who did not (mean 5.1–7.8 vs 1.5–2.2). Clinicians were more likely to recommend a change of prescription once they had seen the full patient profile than after the simulated discussion (12.3–30.2% increase in prescription change), indicating that clinicians rely on their patients to speak up proactively about any concerns. Family planning and bleeding issues were frequently not discussed in consultations.Conclusions: Existing counselling practices appear insufficient to capture patient needs, with opportunities for shared decision-making and discussion being missed. Clinicians and contraceptive counselling services should aim to introduce more in-depth contraceptive counselling, incorporating clear, open-ended questions, to improve patient adherence and enhance reproductive planning. Women should be empowered to actively voice both their needs and any dissatisfaction with their current contraceptive.