A conceptual framework for patient-centered fertility treatment.
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BACKGROUND: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.
Fertilization in Vitro
Reproductive Health Services
Published Version (Please cite this version)10.1186/s12978-017-0375-5
Publication InfoDuthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Schoyer, Katherine D; Sandlow, Jay; Strawn, Estil Y; & Flynn, Kathryn E (2017). A conceptual framework for patient-centered fertility treatment. Reproductive health, 14(1). pp. 114. 10.1186/s12978-017-0375-5. Retrieved from https://hdl.handle.net/10161/21075.
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Assoc Dir, Educ & Training
Adjunct Professor in the Department of Population Health Sciences
Kathryn E. Flynn, PhD, is an adjunct assistant professor in psychiatry and behavioral sciences at the Duke University School of Medicine. She works primarily at the Duke Clinical Research Institute. Dr. Flynn was trained in sociology and population health sciences at the University of Wisconsin, where she worked with Maureen Smith on the development and fielding of new survey instruments to assess health care access and utilization in the near elderly as part of the Wisconsin Longitu
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