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Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care.
Hum Reprod 2016; 31(1):108-16HR

Abstract

STUDY QUESTION

Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up?

SUMMARY ANSWER

Tailored expectant management of at least 6 months in couples with unexplained infertility is not associated with the experiences with quality of care or trust in their physician.

WHAT IS KNOWN ALREADY

In couples with unexplained infertility and a good prognosis of natural conception within 1 year, expectant management for 6-12 months does not compromise ongoing birth rates and is equally as effective as starting medically assisted reproduction immediately. Therefore, TEM is recommended by various international clinical guidelines. Implementation of TEM is still not optimal because of existing barriers on both patient and professional level. An important barrier is the hesitance of professionals to counsel their patients for TEM because they fear that patients will be dissatisfied with care. However, if and how adherence to TEM actually affects the couples' experience with care is unknown. Experiences with the quality care can be measured by evaluating the patient-centredness of care and the patients' trust in their physician.

STUDY DESIGN, SIZE, DURATION

This is a retrospective cross-sectional study. A survey with written questionnaires was performed among all couples who participated in the retrospective audit of guideline adherence on TEM in 25 Dutch clinics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis (>30%) of natural conception within 1 year based on the Hunault prediction model. We used patient's questionnaires to collect data on the couples' experience with the quality of care and possible confounders for their experiences other than having undergone TEM or not. Multilevel regression analyses were performed to investigate case-mix adjusted association of TEM with the patient-centredness of care (PCQ-Infertility) and the patients' trust in their physician (Wake Forest Trust Scale).

MAIN RESULTS AND THE ROLE OF CHANCE

Couples who adhered to TEM experienced the quality of care on the same level as couples who were exposed to early treatment, i.e. started fertility treatment within 6 months after fertility work-up. There were no associations between adherence to TEM and the patient-centredness of care or the patients' trust in their physician.

LIMITATIONS, REASONS FOR CAUTION

Because this study is retrospective, recall bias might occur. Furthermore, we were unable to measure the difference in experience with care over time. Therefore, our results have to be interpreted carefully.

WIDER IMPLICATIONS OF THE FINDINGS

Prospective research on couples undergoing TEM have to be performed to provide more detailed insight in the patients' experiences with the decision making process and subsequently the expectant period. Tackling the barriers surrounding TEM, i.e. better counselling and more patient information material, could further improve patient experiences with the quality of care for couples who are advised TEM.

STUDY FUNDING/COMPETING INTERESTS

Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none.

TRIAL REGISTRATION NUMBER

www.trialregister.nl NTR3405.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.Scientific institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.Department of Obstetrics and Gynaecology, Slingeland Ziekenhuis, PO Box 169, 7000 AD, Doetinchem, The Netherlands.Department of Obstetrics and Gynaecology, Wilhelmina Ziekenhuis Assen, PO Box 30001, 9400 RA, Assen, The Netherlands.Department of Obstetrics and Gynaecology, Isala Clinics, PO Box 10400, 8000 GK, Zwolle, The Netherlands.Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, PO Box 22660, Amsterdam DD 1100, The Netherlands.The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5005 SA Adelaide, Australia.Centre for Reproductive Medicine, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands.Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands willianne.nelen@radboudumc.nl.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26573527

Citation

Kersten, F A M., et al. "Tailored Expectant Management in Couples With Unexplained Infertility Does Not Influence Their Experiences With the Quality of Fertility Care." Human Reproduction (Oxford, England), vol. 31, no. 1, 2016, pp. 108-16.
Kersten FA, Hermens RP, Braat DD, et al. Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care. Hum Reprod. 2016;31(1):108-16.
Kersten, F. A., Hermens, R. P., Braat, D. D., Tepe, E., Sluijmer, A., Kuchenbecker, W. K., ... Nelen, W. L. (2016). Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care. Human Reproduction (Oxford, England), 31(1), pp. 108-16. doi:10.1093/humrep/dev277.
Kersten FA, et al. Tailored Expectant Management in Couples With Unexplained Infertility Does Not Influence Their Experiences With the Quality of Fertility Care. Hum Reprod. 2016;31(1):108-16. PubMed PMID: 26573527.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care. AU - Kersten,F A M, AU - Hermens,R P G M, AU - Braat,D D M, AU - Tepe,E, AU - Sluijmer,A, AU - Kuchenbecker,W K, AU - Van den Boogaard,N, AU - Mol,B W J, AU - Goddijn,M, AU - Nelen,W L D M, AU - ,, Y1 - 2015/11/16/ PY - 2015/03/26/received PY - 2015/10/13/accepted PY - 2015/11/18/entrez PY - 2015/11/18/pubmed PY - 2016/9/28/medline KW - early treatment KW - expectant management KW - experience with care KW - guideline adherence KW - patient-centredness KW - prognostic model KW - trust in physician KW - unexplained infertility SP - 108 EP - 16 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 31 IS - 1 N2 - STUDY QUESTION: Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up? SUMMARY ANSWER: Tailored expectant management of at least 6 months in couples with unexplained infertility is not associated with the experiences with quality of care or trust in their physician. WHAT IS KNOWN ALREADY: In couples with unexplained infertility and a good prognosis of natural conception within 1 year, expectant management for 6-12 months does not compromise ongoing birth rates and is equally as effective as starting medically assisted reproduction immediately. Therefore, TEM is recommended by various international clinical guidelines. Implementation of TEM is still not optimal because of existing barriers on both patient and professional level. An important barrier is the hesitance of professionals to counsel their patients for TEM because they fear that patients will be dissatisfied with care. However, if and how adherence to TEM actually affects the couples' experience with care is unknown. Experiences with the quality care can be measured by evaluating the patient-centredness of care and the patients' trust in their physician. STUDY DESIGN, SIZE, DURATION: This is a retrospective cross-sectional study. A survey with written questionnaires was performed among all couples who participated in the retrospective audit of guideline adherence on TEM in 25 Dutch clinics. PARTICIPANTS/MATERIALS, SETTING, METHODS: Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis (>30%) of natural conception within 1 year based on the Hunault prediction model. We used patient's questionnaires to collect data on the couples' experience with the quality of care and possible confounders for their experiences other than having undergone TEM or not. Multilevel regression analyses were performed to investigate case-mix adjusted association of TEM with the patient-centredness of care (PCQ-Infertility) and the patients' trust in their physician (Wake Forest Trust Scale). MAIN RESULTS AND THE ROLE OF CHANCE: Couples who adhered to TEM experienced the quality of care on the same level as couples who were exposed to early treatment, i.e. started fertility treatment within 6 months after fertility work-up. There were no associations between adherence to TEM and the patient-centredness of care or the patients' trust in their physician. LIMITATIONS, REASONS FOR CAUTION: Because this study is retrospective, recall bias might occur. Furthermore, we were unable to measure the difference in experience with care over time. Therefore, our results have to be interpreted carefully. WIDER IMPLICATIONS OF THE FINDINGS: Prospective research on couples undergoing TEM have to be performed to provide more detailed insight in the patients' experiences with the decision making process and subsequently the expectant period. Tackling the barriers surrounding TEM, i.e. better counselling and more patient information material, could further improve patient experiences with the quality of care for couples who are advised TEM. STUDY FUNDING/COMPETING INTERESTS: Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none. TRIAL REGISTRATION NUMBER: www.trialregister.nl NTR3405. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/26573527/Tailored_expectant_management_in_couples_with_unexplained_infertility_does_not_influence_their_experiences_with_the_quality_of_fertility_care_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dev277 DB - PRIME DP - Unbound Medicine ER -