Quality Counseling

Quality counseling is fundamental to the delivery of person-centered care. Five key principles guide quality counseling:

Establish and maintain rapport with the person.
Rapport is fundamental for establishing trust and open communication and has been shown to affect outcomes, including patient satisfaction.

Several elements build rapport:

Simple acts such as a warm welcome, a handshake, and "taking the time to connect as human beings"54
Ensuring privacy and confidentiality
Asking permission to discuss SRH topics as well as inquiring, acknowledging, and centering the person's goals and desires for the visit
Matching the patient’s tone, paraphrasing what the patient has said, and asking if you got it right
Focus more attention on respectful listening versus talking "at the patient"

Assess the person’s preferences, values, and goals; personalize discussions accordingly.
Both open-ended discussion and structured questionnaires can contribute to understanding patient preferences, values, and goals. Assessment should encompass not only the type of care but also the type of information a person might want or need as well as how the person prefers to receive information and make decisions. Meet people where they are. Avoid attempts to redirect their goals. Set aside personal biases that may conflict with patient preferences and work to support the patient’s desired outcomes.
Work with the person to interactively establish a plan.
Establishing a plan includes setting goals, using a strengths-based approach in discussing possible difficulties, and developing action plans to deal with these difficulties. Ground all plans in the individual’s own goals, interests, and readiness for change.
Provide accurate and understandable information that supports the person’s desires.
Provide information that is balanced, nonjudgmental, and supported by scientific research. Educational materials and decision aids should be offered in a variety of formats (written, audio/visual, video, interactive) to enable patients to select the format(s) that work best for them. Visual and tactile aids can help patients integrate new information that is relevant to their decision making.55, 56, 57 Many people have basic or below-basic health literacy; understanding health information improves short- and long-term health outcomes and is essential for shared decision making.58 The Agency for Healthcare Research and Quality (AHRQ) offers resources for evaluating educational materials to ensure that they are easy to read and understand.59 Test all educational materials with the intended audiences for clarity and comprehension before wide-scale use, specifically involving individuals who are representative of the populations served.
Confirm understanding.
Most people do not understand or recall all the information they are offered in a clinical encounter.60 Asking people to repeat back what they heard (“teach-back”) can be a helpful way of confirming their understanding and determining what additional information sharing may be needed.59 For example, “I’ve shared a lot of information and I want to be sure I was clear, can you tell me what you understood about [topic]?”

Shared Decision Making (SDM), which is one approach to quality counseling, is a joint process in which the health care provider and patient work jointly to help the patient make decisions about their care. For all of the components described above, a shared decision-making approach is recommended. In an SDM model, the patient shares their values and preferences, and the provider shares relevant information with the patient. The provider and patient then work together to determine what clinically appropriate course of action suits the patient’s preferences, clinical needs, and goals. Not all patients wish to engage in SDM, and the patient’s decision-making preferences should be respected. In the SRH context, SDM has been shown to improve the quality of contraceptive counseling and contraceptive method satisfaction and is recommended in the delivery of a wide range of SRH services, including pelvic examinations and HIV pre-exposure prophylaxis (PrEP).61, 62, 63

Resources for Providers

Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

Source:

Annals of Family Medicine

54
English W, Gott M, Robinson J. The meaning of rapport for patients, families, and healthcare professionals: a scoping review. Patient Education and Counseling. 2022;105(1):2-14.
55
Dehlendorf C, Vittinghoff E, Fitzpatrick J, et al. A Decision Aid to Help Women Choose and Use a Method of Birth Control. 2023.
56
Koo HP, Wilson EK, Minnis AM. A computerized family planning counseling aid: a pilot study evaluation of smart choices. Perspectives on sexual and reproductive health. 2017;49(1):45-53.
57
Pazol K, Zapata LB, Dehlendorf C, Malcolm NM, Rosmarin RB, Frederiksen BN. Impact of contraceptive education on knowledge and decision making: an updated systematic review. American journal of preventive medicine. 2018;55(5):703-715.
58
Coughlin SS, Vernon M, Hatzigeorgiou C, George V. Health literacy, social determinants of health, and disease prevention and control. Journal of environment and health sciences. 2020;6(1).
59
Agency for Healthcare Research and Quality. Use the Teach-Back Method: Tool 5.
59
Agency for Healthcare Research and Quality. Use the Teach-Back Method: Tool 5.
60
Yen PH, Leasure AR. Use and effectiveness of the teach-back method in patient education and health outcomes. Federal practitioner. 2019;36(6):284.
61
Dehlendorf C, Grumbach K, Schmittdiel JA, Steinauer J. Shared decision making in contraceptive counseling. Contraception. 2017;95(5):452-455.
62
Sewell WC, Solleveld P, Seidman D, Dehlendorf C, Marcus JL, Krakower DS. Patient-led decision-making for HIV preexposure prophylaxis. Current HIV/AIDS Reports. 2021;18:48-56.
63
Chor J, Stulberg DB, Tillman S. Shared decision-making framework for pelvic examinations in asymptomatic, nonpregnant patients. Obstetrics & Gynecology. 2019;133(4):810-814.