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.

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Description

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Citation

Published Version (Please cite this version)

10.1186/s12978-017-0375-5

Publication Info

Duthie, Elizabeth A, Alexandra Cooper, Joseph B Davis, Katherine D Schoyer, Jay Sandlow, Estil Y Strawn and Kathryn E Flynn (2017). A conceptual framework for patient-centered fertility treatment. Reproductive health, 14(1). p. 114. 10.1186/s12978-017-0375-5 Retrieved from https://hdl.handle.net/10161/21075.

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Scholars@Duke

Cooper

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 joining the Purpose Project she worked at Duke's Social Science Research Institute, first as its Administrative Director and subsequently as its Associate Director for Education and Training.  She has guided and directed a wide range of collaborative educational programming and services and devoted  effort to a wide range of research projects, supporting both quantitative and qualitative data collection, management, analysis, and reporting.  Prior to coming to Duke, she held faculty positions at Lafayette College and the University of North Carolina - Charlotte.  She holds a B.A. in Political and Social Thought and in French from the University of Virginia and a Ph.D. in Political Science from the University of North Carolina - Chapel Hill.

Flynn

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 Longitudinal Study, a long-term cohort study with over 10,000 participants. In 2005, Dr. Flynn was awarded an R36 dissertation grant from the Agency for Healthcare Research and Quality to use the Wisconsin Longitudinal Study to examine preferences for health care decision making among older adults. Findings from this research have been published in Social Science and Medicine and the Journal of General Internal Medicine. As a postdoctoral fellow at the Duke Clinical Research Institute, Dr. Flynn trained under Kevin Weinfurt, gaining experience in the design and analysis of patient-reported outcomes in clinical trials.

Dr. Flynn's research interests include shared medical decision making; patient-provider relationships, including communication, trust, and technology; quality of medical care; patient-reported outcomes in clinical trials; and quantitative and qualitative methods in behavioral research.

Areas of Expertise: Health Measurement, Health Services Research, and Health Behavior


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