Counselling patients

Step by Step Guide:

45 seconds
Step 1: Establish her contraceptive needs
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In this step, HCPs should:
• Understand what a woman wants from her contraception
• Discover what previous methods of contraception she has used including the pros and cons
• Establish her goals in the coming years
 
Step 1 - Starting the conversation
To establish a women’s contraceptive needs:
• Form questions that match a woman’s goals and needs, for example:

• Understand her experience of different methods:

30 seconds
Step 2: Introduce long-acting reversible contraception (LARC)
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In this step, HCPs should:
• Use a women’s contraceptive needs to link to LARC (if appropriate)
• Introduce IUC as a method of LARC
• Increase a woman’s awareness and knowledge of LARC
• Bear in mind that a woman’s contraceptive needs change through her life – LARC may be an option in the future if it isn’t right now
 
Step 2 - Linking to LARC
• Encourage HCPs to continue to ask a woman about her contraception as her needs change throughout her reproductive life
• Use simple linking phrases to increase awareness and knowledge about LARC using her established contraceptive needs:

Step 2 - Introducing IUC
• Once interest in a long-acting method of contraception is confirmed, introduce IUC as a potential method:

90 seconds
Step 3: Communicate the potential benefits of IUC
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In this step, HCPs should:
• Discuss the potential benefits of IUC, linking back to her contraceptive needs
• Use extra time to compare benefits to other methods
• Discuss non-contraceptive benefits of some IUC methods
 
Step 3 - Discussing the benefits of IUC
• Discuss the key potential benefits of IUC with the woman:
  • Highly effective
  • Cost-effective
  • No need for daily, weekly or monthly administration
  • Potential non contraceptive benefits
  • Rapidly reversible
  • Inserted quickly
• Supporting information is provided for HCPs
• This step includes discussion points for extra time
 
Step 3 - Extra time?
• In certain cases, you may find that you have a little more time available with your patient. If so, consider discussing:

90 seconds
Step 4: Provide reassurance and address her concerns
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In this step, HCPs should:
• Build clinical knowledge to dispel common misperceptions around IUC
• Feel confident in addressing these with a woman to reassure her
• Put risks and side effects into perspective in relation to other methods and pregnancy itself
 
Step 4 - Background Reading - Common barriers and myths
• Many HCPs have misconceptions about IUC which results in them not proactively discussing or offering it as part of their contraceptive discussion
• To dispel many of the common barriers and myths, the Global INTRA Group have developed a review paper published in EJC.

• Further barriers the use of IUC covered in this review paper include:

Step 4 - Addressing ‘user’ barriers
• Women also have a number of misconceptions about IUC which may need to be addressed within a consultation:

Step 4 - Putting risks and side-effects into perspective
• Any method of contraception has risks and side effects. Helping a woman make an informed choice about IUC involves an appropriate discussion of these, using your clinical knowledge and experience.
 
For example:
• Risk of ectopic pregnancy
• Perforation
• Expulsion
• Infection
• Changes to her monthly bleeding pattern

Step 4 - Extra time?
• If possible, this theme can be expanded upon by discussing the CHOICE study:

60 seconds
Step 5: Help her decide
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In this step, HCPs should:
• Use clinical experience to support a woman in deciding whether to use IUC – referring back to her initial contraceptive needs
• Address any further concerns a woman may have openly and honestly
• Offer personal experience
 
Step 5 - Use clinical experience and be honest when addressing concerns
• Share your knowledge and clinical experience to support her decision to use IUC
• Bear in mind that IUC won’t be the right choice for every woman

• Include risks and potential side effects into your counselling

Step 4 - Addressing ‘user’ barriers
• If pertinent, personal disclosure has been found to be useful at this time:

60 seconds
Step 6: Confirm her choice and schedule placement (if choice was IUC)
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In this step, HCPs should:
• Offer guidance to confirm a woman’s choice of IUC
• Explain that insertion can take place within 7 days of the onset of menstruation. This is to ensure she is not pregnant.
• Answer any final questions
• Run through final formalities ahead of insertion
 
Step 6 - Provide reassurance
• Offer guidance to confirm a woman’s choice of IUC including:

Step 6 - Ahead of insertion
• Before proceeding with IUC insertion, ensure that: