Assessing comprehension of the Parenting/Pregnancy Attitudes, Timing, and How Important (PATH) questions through cognitive interviewing.

OBJECTIVES: PATH, "Parenting/Pregnancy Attitudes, Timing, and How Important," is a method for providers to engage in a person-centered discussion about reproductive desires. This study sought to assess patient understanding of and receptivity to PATH questions. STUDY DESIGN: Cognitive interviews were conducted with young adult (aged 18-29 years) patients at a federally qualified health center in New York (n = 10). RESULTS: Participants demonstrated clear comprehension and comfort with the PATH questions. IMPLICATIONS: These data provide needed person-driven support for the Centers for Disease Control and Prevention and the Society of Family Planning's recommendation to implement PATH questions as a patient-centered method for discussing an individual's reproductive desires.

Variability in Contraceptive Clinical Trial Design and the Challenges in Making Comparisons Across Trials.

Clinical trials of contraceptives have often differed in their study designs, making cross-trial comparisons difficult. This brief report outlines some of the technical design features that can vary from trial to trial. For example, the overall number of menstrual cycles in a study has substantial impact on the final efficacy determination; however, the rules related to qualifying cycles can differ based on the length of the study and the statistical analysis plan. In two commonly used methods of calculating efficacy, the Pearl Index and the time-to-event analysis, inclusion of fewer menstrual cycles results in higher calculated failure rates. Statistical analysis plans for contraceptive trials have sometimes excluded menstrual cycles because of an absence of documented vaginal intercourse and the concomitant use of another birth control method. Other design features that have varied between contraceptive trials relate to body mass index inclusion/exclusion criteria and the definition of "on-treatment" pregnancy. In addition, study designs of non-hormonal products can differ from those of hormonal products in their length and rules for qualifying cycles. The Draft Guidance for Hormonal Contraception, published in 2019 by the US Food and Drug Administration (FDA), will hopefully lead to more uniform trial design in the future, particularly for hormonal products. In the meantime, health care providers and patients should be aware of the nuances in trial design that make direct comparisons about relative efficacy challenging.

The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines.

ABSTRACT: The American Cancer Society (ACS) released updated cervical cancer screening guidelines in 2020 that endorse a shift in practice to primary human papillomavirus (HPV) screening in people with a cervix, beginning at ages of 25-65 years. When access to US Food and Drug Administration-approved primary HPV testing is not available, the ACS offers cotesting or cytology as acceptable alternative strategies but suggests that these testing modalities may be excluded from future iterations of the guidelines. The ASCCP recognizes the benefits and risks of primary HPV cervical cancer screening while acknowledging the barriers to widespread adoption, including implementation issues, the impact of limited HPV vaccination in the United States, and inclusion of populations who may not be well represented on primary HPV screening trials, such as underrepresented minorities. The ASCCP endorses the 2018 US Preventive Services Task Force Recommendation Statement and supports the ACS cervical cancer screening guidelines. Most importantly, the ASCCP endorses any cervical cancer screening for secondary prevention of cervical cancer and recommends interventions that improve screening for those who are underscreened or unscreened.

Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions.

OBJECTIVES: To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year. STUDY DESIGN: The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection. RESULTS: Based on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence interval (CI) 1.05-1.24], those who never wanted to become pregnant (PR 1.16; 95% CI 1.07-1.26) or those who were uncertain (PR=1.19; 95% CI 1.09-1.30) were all more likely to select IUDs and implants than women who reported wanting to become pregnant within 5 years. Greater happiness was associated with lower chance of choosing an IUD or implant (PR 0.98; 95% CI 0.96-0.999). Expressed importance of pregnancy prevention was not significantly associated with any specific contraceptive choice. CONCLUSIONS: Pregnancy intentions and happiness about a hypothetical pregnancy were independently associated with selection of IUDs and implants. IMPLICATIONS: Pregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention.

Addressing potential pitfalls of reproductive life planning with patient-centered counseling.

Engaging women in discussions about reproductive goals in health care settings is increasingly recognized as an important public health strategy to reduce unintended pregnancy and improve pregnancy outcomes. "Reproductive life planning" has gained visibility as a framework for these discussions, endorsed by public health and professional organizations and integrated into practice guidelines. However, women's health advocates and researchers have voiced the concern that aspects of the reproductive life planning framework may have the unintended consequence of alienating rather than empowering some women. This concern is based on evidence indicating that women may not hold clear intentions regarding pregnancy timing and may have complex feelings about achieving or avoiding pregnancy, which in turn may make defining a reproductive life plan challenging or less meaningful. We examine potential pitfalls of reproductive life planning counseling and, based on available evidence, offer suggestions for a patient-centered approach to counseling, including building open and trusting relationships with patients, asking open-ended questions, and prioritizing information delivery based on patient preferences. Research is needed to ensure that efforts to engage women in conversations about their reproductive goals are effective in both achieving public health objectives and empowering individual women to achieve the reproductive lives they desire.