Patient-centered approaches for family planning counseling and support: A systematic review.

BackgroundThis paper identifies how patient-centered family planning care has been defined, conceptualized, and measured, describes tools to make family planning care more patient-centered, and discusses their impact on patient satisfaction and family planning outcomes. MethodsWe 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) a strategy for providing patient-centered care, 2) an intervention that used a patient- centered approach, or 3) evidence of the impact of patient-centered approaches. We excluded documents that only recommended using patient-centered approaches. To assess how studies conceptualized patient-centered care, we reviewed how the concept was measured. We identified tools for patient-centered care, and mapped them against the main domains of patient-centered care. We reported the available evidence of the impact on those tools without further statistical analysis. ResultsOur review is based on 33 documents, including three theoretical articles and three systematic reviews. Nine studies addressed womens experiences with family planning counseling, five discussed instruments for measuring the patient-centeredness of care, ten discussed tools for patient-centered family planning, and three discussed broader counseling programs. We identified important differences in how patient-centered family planning care was defined and measured, although most studies emphasized patients needs and preferences, respect for the patient, and informed decision-making. We identified six tools for increasing the patient-centeredness of family planning counseling. None of the tools addressed all domains of patient-centered care. Evidence about the impact of these tools is scarce. Overall, the tools appeared well accepted by both providers and patients. There was some evidence that the tools improved patients perception about the quality of care, but no evidence that the tools improved family planning outcomes. DiscussionLimitations of our study include that our search was restricted to two databases, and that the studies predominantly focused on Western countries which may limit the generalizability of the findings. 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. Although tools for patient-centered care improve the patient experience, there is a need to identify strategies for translating this into improved family planning outcomes. In addition, there is a need to test patient- centered approaches in a wider range of settings.