Defining and conceptualizing patient-centered family planning counseling: A scoping review

Abstract

Background Family planning counseling has long been dominated by the tiered-effectiveness model, which discusses contraceptive methods in order of effectiveness. However, there is growing recognition that patients may prioritize factors other than method effectiveness. This scoping review identifies how patient-centered family planning care has been defined and conceptualized, and discusses the implications for measurement. Methods We systematically searched PubMed and SCOPUS for documents on “patient-centered family planning counseling or support” published between 2013 and 2022. Eligibility criteria included discussion of 1) strategies for providing patient-centered care, 2) interventions using a patient-centered approach, or 3) the impact of patient-centered approaches. We describe the definitions and domains of patient-centered family planning counseling addressed in the literature. Results Our scoping review is based on 33 documents. Only 18 documents clearly defined patient-centered family planning counseling or discussed what it entails. We identified important differences in how patient-centered family planning care was defined. However, most studies emphasized patients’ needs and preferences, respect for the patient, and informed decision-making and can be mapped against the McCormack’s framework for patient-centered communication. Conclusions It is important for studies to more clearly state how they define or conceptualize patient-centered family planning. Inconsistent use of indicators makes it difficult, if not impossible, to make generalized conclusions about the effectiveness of the patient-centered approach relative to the tiered-effectiveness approach. Consistent use of comparable indicators of key domains of patient-centered care is needed to address the gap in evidence about the effectiveness of patient-centered family planning counseling on various family planning outcomes, and to support future interventions. Wider use of existing scales to measure patient-centered family planning care may help standardize the definition of patient-centered care and strengthen the evidence base.