Findings from a European survey-based study with simulated patient consultation

(A) Brief patient profile Reason for consultation ‘I come today for a regular check-up and to renew my contraceptive prescription’ ‘I come today for a regular check-up and to renew my contraceptive prescription’ ‘I come today for a regular check-up and also want to re-evaluate my contraceptive options’ age (years) 23 24 28 Relationship status stable relationship stable relationship stable relationship Parity status No child No child No child Occupation First job after college First job after college Sales person Contraceptive eligibility Eligible for all methods Eligible for all methods Eligible for all methods Contraceptive history Started COCs at 17 years old and has used the same pill (EE/LNG, 21/7-day regimen) for the past 3 years Started COCs at 20 years old and has used the same pill (EE/LNG, 21/7-day regimen) for the past 2 years. Previously using condoms Started COCs at 18 years old and has used the same pill (EE/LNG, 21/7-day regimen) for the past 6 years (B) Full patient profile Family planning ‘If you want to become pregnant, when do you plan to become pregnant?’ ‘Definitely not before I am 30 years old’ ‘Maybe in 6 years…but it’s not that fixed in my mind. I just see myself still doing a lot of other things before becoming a mother’ ‘Perhaps in 6 or 7 years’ ‘How important is it not to become pregnant until then?’ ‘Very important, I don’t even want to think about that happening’ ‘Very important, I don’t even want to think about that happening’ ‘Very important, I don’t even want to think about that happening’ Menstrual experience ‘Do you experience any pain alongside menstruation?’ ‘Not too much, just the usual, I guess…’ ‘I have more headaches than before and I guess it may be related to the pill, but I am not sure. Besides that, I sometimes experience a bit of pelvic pain’ ‘Not too much, just the usual, I guess…’ ‘How intense and how long are your periods?’ ‘Quite regular. Normal, I guess’ ‘Quite regular. Normal, I guess’ ‘Thanks to the pill, my cycle was regular and my bleeding was reduced’ ‘How many days does your period last in total?’ ‘About 4-5 days’ ‘About 4-5 days’ ‘About 4-5 days’ ‘Does the duration/intensity or amount of bleeding during your menstruation disturb you and your routine?’ ‘No.’ It is normal’ ‘No.’ It is normal’ ‘No.’ It is normal’ ‘Would you prefer to have less or less intense menstruation?’ ‘Yes, that would be great’ ‘Yes, that would be great’ ‘Yes, that would be great’ ‘Would it be acceptable to have longer, more intense menstruation?’ ‘Definitely not!’ ‘Definitely not!’ ‘Definitely not!’ ‘Would you be ok not having your period every month?’ ‘Yes. But how would I know I am not pregnant then?’ ‘I know that if I take my pill the right way I should not get pregnant’ ‘Yes. But how would I know I am not pregnant then?’ Lifestyle and awareness ‘Would you say your daily routines allow for regular and timely intake of a pill?’ ‘I guess so…’ ‘Yes’ ‘Yes’ ‘Which methods are you aware of?’ ‘Pill, condom, ring, but most of my friends use the pill’ ‘Pill, condom, injection and IUD’ ‘IUD, condom, pill, ring, temperature method, natural cycles app, diaphragm…’ ‘Have you ever heard about long-acting methods which do not require having to think about it every day?’ ‘Now that you mention it. But all my friends use the pill. I have honestly never considered any option besides that’ ‘Yes, I have. But all my friends use the pill. I have honestly never considered any other option besides that’ ‘Yes, I know there are several ones, and the long protection sounds interesting as I don’t want to be pregnant within the next years’ ‘Would it be a critical issue for you if the option available to meet your need is not reimbursed or has a higher cost to you?’ ‘Well, I’m happy with what I’ve got, but I’m open to suggestions if you think there’s something better for me’ ‘It is good if I do not need to pay, but I’m open to suggestions if you think there’s something better for me’ ‘I obviously don’t want to pay a ton of money for my contraception, but if a hormone-free option costs a bit more, I would be willing to pay that for better health’ Current contraceptive use ‘Do you want to change your current contraceptive method for any reason?’ ‘No, I am fine’ ‘I think I am fine with my current method’ ‘Yes, after exposing my body to hormones for 10 years, I think it’s time to change to a hormone-free option’ ‘Is it difficult for you to use oral contraception?’ ‘It is not hard’ ‘No! It’s OK.’ ‘The daily intake is no problem whatsoever, but the daily hormones? I don’t really know how tough that is on my body…’ ‘How many times did you forget to take the pill over the last 3 months?’ ‘Maybe once or twice…’* ‘Not that often’ ‘Not very often, perhaps once or twice per year’ ‘How concerned have you been, when you forgot to take the pill?’ ‘I was very concerned, but thankfully my period came eventually’ ‘It does not happen that often, so not very’ ‘Not that concerned’ ‘Are you OK with your pill?’ ‘It’s OK. It has done its job so far’ ‘It’s OK. It has done its job so far’ ‘No, I want to stop it’ ‘With your current pill, do you experience anything you are not happy with?’ ‘No’ ‘I have more headaches than before and I guess it may be related to the pill, but I am not sure’* ‘Only that I really don’t feel like myself while I’m on it’ Contraceptive preference ‘What is important to you when choosing a contraceptive method?’ ‘Efficiency.’ I am not a fan of hormones, but it’s more important to me that I do not get pregnant’ ‘I absolutely need to be sure I will not get pregnant. Aside from that it is also important to me not to have side effects and risk thrombosis’ ‘I need to be sure I will not get pregnant and I don’t want hormones. I’m convinced they are not good for my body’* ‘Do you already have any idea what would be a good contraceptive option and method for you?’ ‘I am OK with my current one’ ‘I am OK with my current one. My concerns are more about its side effects and the risk of thrombosis’ ‘A non-hormonal option’ ‘What are concrete and specific concerns you have about hormonal contraception?’ ‘I have never had any issues, but I hear a lot about the risks, and that sounds quite scary to be honest’ ‘You mean besides the usual side effects of it and the risk of thrombosis? I hear a lot of other things, but I am not sure if it really causes cancer or something like that. And supposedly there may be an impact on my libido… I would prefer to avoid that if I can’ ‘I heard that hormones are bad for you. I don’t want to take something every day that messes with my body!’ ‘What exactly bothers you about ‘taking hormones’?’ ‘I may not want to have kids now, but definitely later. I don’t want these hormones to get in the way of that’ ‘I am concerned that taking it may cause side effects and that it is impacting my general well-being’ ‘I don’t know…Exposing your body to this many hormones on a daily basis, it just cannot be good for you, right, doctor?’ ‘Would you prefer a daily or non-daily method? OR do you prefer a specific intake regimen (daily, weekly, monthly, 3 years, 5 years)?’ ‘All of my friends use the pill. I have never considered any other options besides that to be honest’ ‘Actually I prefer daily intake to be in control’ ‘As long as it’s good for my wellbeing and a convenient option, I guess it doesn’t really matter’ ‘Do you have any additional need or expect any specific positive effect from your contraceptive?’ ‘No’ ‘No’ ‘No’

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