A conceptual framework for patient-centered fertility treatment.
Abstract
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.
Type
Journal articleSubject
HumansInfertility
Fertilization in Vitro
Longitudinal Studies
Decision Making
Adult
Reproductive Health Services
Patient-Centered Care
Female
Male
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https://hdl.handle.net/10161/21075Published Version (Please cite this version)
10.1186/s12978-017-0375-5Publication Info
Duthie, 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Alexandra Cooper
Manager, Program Assessment
Alexandra Cooper serves as Associate Director for Evaluation and Assessment within
the Purpose Project in the Kenan Institute for Ethics. She supports the Project in
making question of character, purpose and meaning signature features of the Duke community
by gathering evidence about the Project's programs and their effects and by working
with Project team members to examine and understand what that evidence shows us about
what the Project does and can accomplish.
Prior to joini
Kathryn Eve Flynn
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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