The Framework: Counseling for Patient-Centered Abortion Care

This workshop 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.

How to use these materials:

Learners can watch didactic lectures before the workshop in a flipped classroom model or during the workshop.

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.

Workshop Objectives:

At the end of the workshop, learners will:

  • Acknowledge the potential for a judgmental reaction to interfere with the patient-provider relationship and develop strategies to minimize its interference.
  • Identify strategies for maintaining a positive relationship with patients who make decisions about health care with which you may disagree.

Individual Activity: Decision Counseling for Positive Pregnancy Test Results

 

AFTER WATCHING THESE VIDEO LECTURES, LEARNER WILL:

  • Define patient-centered care
  • Provide objective and compassionate pregnancy options counseling
  • Practice patient communication skills

Group Activity:

Directions:  Play 4 counseling frame-work videos. After these videos, break learners into groups of 3-4. Read the case aloud to the group and ask them to discuss case and questions listed below.

Small Group Activity:

Case study:

Tania is 22 years old and presents at the clinic for a pregnancy test and you find that she is pregnant. She is thoughtful and introspective. She has a moral conflict with abortion but does not desire to parent at this time. Tania asks you whether or not you think abortion is a sin. How would you counsel Tania?

  1. How would you respond to Tania’s question?
  2. What, if any, feelings do you have about Tania’s gestational age?
  3. What are some things that you initially can say to Tania to establish rapport?
  4. How can you tactfully explore her moral conflict with abortion?

Large Group Discussion Questions:

  • Patient calls pregnancy a baby? How does that make you feel? What language would you use with that patient?
  • How would you feel if a patient seeking an abortion wants to keep the ultrasound?
  • What do you think about a patient who returns to your clinic for another abortion? How does that make you feel?

Facilitation Notes: Teaching Points

  • There is no knowledge that you possess about the answer to the patient’s dilemma that they do not.
  • One pregnancy decision is not “more moral” than another; she is a good person making a moral decision for herself.
  • Building rapport with patients starts with establishing trust that you are giving them accurate unbiased information and don’t have an agenda.
  • Create a space where patients feel that it is safe to ask questions.
  • Establish an environment free of stigma around pregnancy decisions by modeling unbiased language.

Readings:

  • Perrucci, Alissa. Decision Assessment and Counseling in Abortion Care: Philosophy and Practice. 2012.
  • Moore A, Frohwirth L and Blades N, What women want from abortion counseling in the United States: a qualitative study of abortion patients in 2008, Social Work in Health Care, 2011, 50(6):424–442.
  • 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.