The Framework: Counseling for Patient-Centered Abortion Care
Course Information & Objectives
This course is intended to teach patient-centered pregnancy decision counseling in patient scenarios that often prove challenging. Healthcare providers, including physicians, nurse practitioners, nurses, counselors, or clinic staff, often lack the training, language, or techniques to guide patients to self-directed decisions. This is especially evident in sexual and reproductive health (SRH) where stigma makes open discussion uncomfortable for patients and providers alike.
The WHO Clinical Practice Handbook for Safe Abortion Care requires counseling “using simple language, maintaining privacy, supporting women to ask questions and taking time to give answers, and not imposing our personal values and beliefs.” Patient-centeredness is one of the National Academy of Medicine’s six dimensions of health care quality. This intentional approach requires the provision of care that is respectful of and responsive to individual patient preferences, needs, and values and empowers people to take charge of their own health.
At the end of the course, learners will:
- Recognize areas in your practice where you may experience a judgmental reaction to patient statements, questions and decisions.
- Apply conversational techniques for maintaining a positive relationship with patients who make decisions about health care with which you may disagree.
- Compare and contrast different words and phrases that are used in options counseling.
- Analyze alternative responses to patient statements.
- Practice techniques for talking with patients about their pregnancy decisions
How to use these materials
The small group activity is based on a didactic video lecture, Decision Counseling for Positive Pregnancy Test Results, that provides a knowledge base, terminology, and techniques, along with group activities and case studies. The Framework, which is comprised of four counseling videos, is intended to provide learners with a counseling framework and facilitate patient-centered counseling.
Learners may watch the didactic lecture and counseling videos during course time.
Learners can watch the didactic lecture and counseling videos in a flipped classroom model, where learners watch the videos and study course materials/concepts outside of class, before completing the discussion activities during class time.
For self-paced learning:
Learners should watch all videos on their own, write down answers to each of the discussion questions, and reflect on each of their responses.
Decision Counseling for Positive Pregnancy Test Results
- Learners can watch this didactic lecture in a flipped classroom model before completing the activities or may watch it during course time.
- Learners may be assigned any of the relevant readings found in the “Facilitator Notes & Teaching Points” section below (determined by the instructor’s desired learner workload).
The Framework: The Patient Has the Answer
The Patient has the Answer Summary: Only the patient is the expert in their life and needs.
The Framework: Liberation
Liberation summary: Healthcare providers may have bias favoring a particular decision, but the patient owns the decision and ultimately it does not impact the providers life.
The Framework: Not A Failure
Not a Failure Summary:
- A patient who returns for a second or greater abortion indicates that the clinic and staff provided high-quality service and supported the patient.
- Viewing repeat patients as “failures” contributes to abortion shame and stigma
The Framework: The Approach
The Approach Summary :
- Patient-centered counseling uses this approach: Listen, don’t assume, self-reflect.
- Patients and providers may not share understanding of complex medical terms
Group Activities or Self-Reflections
After watching the above videos, break learners into groups of 3-4. Read the case aloud to the group and ask learners to discuss the case and questions listed below.
Small Group Activity
Tania is 22 years old and presents at the clinic for a pregnancy test and you find that she is pregnant. When you present the results of the pregnancy test, she begins to cry.
- How might you respond to Tania after she begins to cry?
- What is an example of an open-ended question that you could ask to see what Tania is thinking or feeling?
- When Tania states that she is unsure about what she wants to do, give an example of how to normalize or validate her uncertainty.
- Next, give an example of an open-ended question you could use to open up the conversation and inquire as to her thoughts about her options.
Large Group Discussion Questions
- What if a patient presenting for abortion calls the pregnancy a “baby”?
- What feelings come up for you?
- What language would you use with that patient?
- What might be some unintended, negative consequences of correcting a patient’s use of the word “baby” in favor of medical terminology such as “embryo”?
- Why do patients use the word “baby” to refer to their pregnancies?
- How would you feel if a patient seeking an abortion wants to keep an image from the ultrasound?
- What do you think about a patient who returns to your clinic for another abortion?
- Why do some healthcare providers see that as a “failure”? How can it instead be seen as a success?
Facilitator Notes & Teaching Points
Facilitator Notes & Teaching Points
- Your own liberation rests upon the belief that your patient is the expert on her own life.
- Building rapport with patients starts with establishing trust that you are giving them accurate, unbiased information and that you don’t have an agenda or a preference for which decision they make.
- Create a space where patients feel that it is safe to ask questions. You do this by being quiet and allowing the patient to speak, asking open-ended questions, and validating and normalizing what the patient brings to the conversation.
- Establish an environment free of stigma around pregnancy decisions by modeling unbiased language about parenting, abortion and adoption.
- Perrucci, Alissa. Decision Assessment and Counseling in Abortion Care: Philosophy and Practice. 2012.
- Gould H, Foster DG, Perrucci AC, Barar RE, Roberts SC. Predictors of abortion counseling receipt and helpfulness in the United States. Women’s Health Issues (2013) Jul-Aug; 23(4):e249-e255. 9.
- Gould H, Perrucci A, Barar R, Sinkford D, Foster DG. Patient education and emotional support practices in abortion care facilities in the United States. Women’s Health Issues. (2012) Jul-Aug; 22(4):e359-e364.
- Altshuler, AL, Ojanen-Goldsmith, A, Blumenthal, PD, Freedman, LR. A good abortion experience: A qualitative exploration of women’s needs and preferences in clinical care (2017). Social Science & Medicine 191, 109-116.
- Foster DG et al., Attitudes and decision making among women seeking abortions at one U.S. clinic, Perspectives on Sexual and Reproductive Health, 2012, 44(2):117–124.