Duthie, E. A., Cooper, A., Davis, J. B., Schoyer, K. D., Sandlow, J., Strawn, E. Y., & Flynn, K. E. (2017). A conceptual framework for patient-centered fertility treatment. Reproductive health. https://doi.org/10.1186/s12978-017-0375-5
Duthie EA, Cooper A, Davis JB, Schoyer KD, Sandlow J, Strawn EY, Flynn KE. A conceptual framework for patient-centered fertility treatment. Reproductive health. 2017. doi:10.1186/s12978-017-0375-5
Duthie, Elizabeth A., et al. "A conceptual framework for patient-centered fertility treatment." Reproductive health, 2017.
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RRM Academy Synopsis
A revised patient-centered fertility framework has six dimensions
The authors hold that fertility care should count six things couples weigh, from effectiveness to genetic parentage. They built this on interviews with both partners in 37 couples at one US infertility practice and revised a 2014 framework. Couples weighed the dimensions against each other.
Key Findings
The authors conclude that treatment "should account for the dimensions" patients and partners weigh. The six are effectiveness, burden (physical and emotional), time, cost, potential risks and genetic parentage.
The revised framework keeps 3 dimensions of the 2014 framework unchanged, modifies 1 (safety became potential risks) and adds 2 (time and genetic parentage).
Participants weighed tradeoffs across dimensions. The authors say specialists "should help patients" identify and weigh those tradeoffs.
Effectiveness was the dimension "most prominently considered". Participants weighed the effectiveness they hoped IVF would offer against its heavier burden and its cost.
Participants did not seem to treat potential risks as an important dimension. The authors hold that clinicians "must continue" to educate patients about treatment risks.
Interpretation
The study is a prospective, longitudinal mixed methods design. Both partners were interviewed separately at six time points over 12 months, and 37 couples completed it. Couples came from one infertility practice near Milwaukee and had not previously had a child through ART. The quotations and case detail come from 8 participants in couples who had IVF. The study describes what participants said and measures no treatment outcomes. The authors note the framework covers medical treatments and could be widened to expectant management, adoption or living child-free.
RRM Context
The six dimensions describe how couples compare treatments once a treatment decision is on the table. Restorative reproductive medicine asks an earlier question: why is conception not happening? The framework leaves that out. RRM is couple-centered, and the study interviewed both partners separately. Partners in the sample sometimes weighed dimensions differently.
Our editorial summary of this paper, not the article's abstract.
Abstract
Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for infertility, this revised conceptual framework can be used to inform patient-centered treatment and research on infertility and to develop decision support tools for patients and providers.
Ethics and Policy › Informed Consent › Patient Preferences and Priorities · Assisted Reproduction › Safety and Risks › Procedural Safety
Elizabeth A Duthie, Alexandra Cooper, Joseph B Davis, Katherine D Schoyer, Jay Sandlow, Estil Y Strawn, Kathryn E Flynn
Liz Duthie, Beth Duthie, Betsy Duthie, E Duthie, Alex Cooper, A Cooper, Joe Davis, Joey Davis, J Davis, Kathy Schoyer, Kate Schoyer, Katie Schoyer, K Schoyer, J Sandlow, E Strawn, Kathy Flynn, Kate Flynn, K Flynn
PMID 28882134 28882134 DOI 10.1186/s12978-017-0375-5 10.1186/s12978-017-0375-5 Duthie et al. 2017, Duthie 2017