CONTENTS
Chapters
- Research and Regulatory Approval
- Use of Injectables
- Effectiveness and Reversibility
- Side Effects and Complications
- More Evidence in the Cancer Debate
- Noncontraceptive Health Benefits
- Counseling Issues
- Communicating with the Public
- Maximizing Access and Quality
Published with this issue:
HIGHLIGHTS
Published by the Population Information Program, Center for Communication
Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland
21202-4012, USA
Volume XXIII, Number 2
August 1995 |
Counseling About
Side Effects
Program managers may consider a number of factors, some of
which conflict, in deciding what providers should tell clients
about side effects or should be prepared to discuss with clients.
For example:
- Time. Providers may have just a few minutes to talk
with each client and dispense a method. A few extra
minutes in initial counseling, however, could save more
time later when women return because of unexpected side
effects.
- Clients' reactions to unexpected side effects. People
often tolerate side effects that they expect but may
discontinue a method if they are surprised by a side
effect. Unless clients are told, they have no way to
know whether the side effect is minor or serious, or
whether it will get worse and threaten their health or
instead eventually will diminish or disappear.
- Clients' reaction to a long list of side effects. Some
providers fear that mentioning side effects may
discourage clients from using a method (188).
Descriptions of serious but rare side effects may be
especially frightening to clients. Also, providers
should avoid giving clients more information than they
can absorb in a short counseling session. Studies in
developed countries, however, find that patients,
including OC users, generally want detailed information
about side effects, while doctors and pharmacists
prefer to discuss only serious side effects and the
most common minor effects (196, 226). Providers might
ask clients if they want to know all the side effects
of a drug or procedure or just the ones that are most
common (250).
- Clients' understanding of risk. How can providers make
the concept of probability understandable? Describing a
slight risk of a serious side effect may be especially
difficult. How risks are presented can influence a
client's choice. In a study of treatment for lung
cancer, for example, both doctors and patients
preferred a treatment described as having a 90%
survival rate after one year to an identical treatment
described as having a 10% mortality rate after one year
(203). Thus, family planning providers may point out
that, while 5% of users experience a side effect, 95%
do not.
- Cultural or religious customs. These may limit
discussion between client and provider. For example, in
some cultures clients may not expect to ask questions
or to have long discussions with providers, who have
higher social status than they do (281). Women may not
want to discuss intimate matters with male providers
(292). Where possible, managers may arrange for female
providers to counsel female clients.
- Clients' concerns. Providers should be able to reassure
clients if they raise concerns about reports in the
mass media or rumors from friends or relatives. During
education sessions in the McCormick Family Planning
Program, for example, providers asked groups of 5 to 15
clients about the rumors that they had heard about DMPA
and then provided accurate information (199).
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