Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception

N M van den Boogaard, E van den Boogaard, E Bokslag, M C B van Zwieten, P G A Hompes, S Bhattacharya, W Nelen, F van der Veen, B W J Mol

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: European guidelines on fertility care emphasize that subfertile couples should receive information about their chances of a natural conception and should not be exposed to unnecessary treatments and risks. Prognostic models can help to estimate their chances and select couples with a good prognosis for tailored expectant management (TEM). Nevertheless, TEM is not always practiced. The aim of this study was to identify any barriers or facilitators for TEM among professionals and subfertile couples.

METHODS: A qualitative study was performed with semi-structured in-depth interviews of 21 subfertile patients who were counselled for TEM and three focus-group interviews of 21 professionals in the field of reproductive medicine. Two theoretical models were used to guide the interviews and the analyses. The primary outcome was the set of identified barriers and facilitators which influence implementation of TEM.

RESULTS: Among the subfertile couples, main barriers were a lack of confidence in natural conception, a perception that expectant management is a waste of time, inappropriate expectations prior to the first consultation, misunderstanding the reason for expectant management and overestimation of the success rates of treatment. Both couples and professionals saw the lack of patient information materials as a barrier. Among professionals, limited knowledge about prognostic models leading to a decision in favour of treatment was recognized as a main barrier. A main facilitator mentioned by the professionals was better management of patients' expectations.

CONCLUSIONS: We identified several barriers and facilitators which can be addressed to improve the implementation of TEM. These should be taken into account when designing future implementation strategies.
Original languageEnglish
Pages (from-to)2122-2128
Number of pages7
JournalHuman Reproduction
Volume26
Issue number8
Early online date10 Jun 2011
DOIs
Publication statusPublished - Aug 2011

Fingerprint

Interviews
Reproductive Medicine
Focus Groups
Fertility
Theoretical Models
Therapeutics
Referral and Consultation
Guidelines

Keywords

  • infertility
  • prognostic models
  • implementation
  • barriers
  • expectant management

Cite this

Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception. / van den Boogaard, N M; van den Boogaard, E; Bokslag, E; van Zwieten, M C B; Hompes, P G A; Bhattacharya, S; Nelen, W; van der Veen, F; Mol, B W J.

In: Human Reproduction, Vol. 26, No. 8, 08.2011, p. 2122-2128.

Research output: Contribution to journalArticle

van den Boogaard, NM, van den Boogaard, E, Bokslag, E, van Zwieten, MCB, Hompes, PGA, Bhattacharya, S, Nelen, W, van der Veen, F & Mol, BWJ 2011, 'Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception', Human Reproduction, vol. 26, no. 8, pp. 2122-2128. https://doi.org/10.1093/humrep/der175
van den Boogaard, N M ; van den Boogaard, E ; Bokslag, E ; van Zwieten, M C B ; Hompes, P G A ; Bhattacharya, S ; Nelen, W ; van der Veen, F ; Mol, B W J. / Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception. In: Human Reproduction. 2011 ; Vol. 26, No. 8. pp. 2122-2128.
@article{863ae79535b04957803098a1ffa55e53,
title = "Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception",
abstract = "BACKGROUND: European guidelines on fertility care emphasize that subfertile couples should receive information about their chances of a natural conception and should not be exposed to unnecessary treatments and risks. Prognostic models can help to estimate their chances and select couples with a good prognosis for tailored expectant management (TEM). Nevertheless, TEM is not always practiced. The aim of this study was to identify any barriers or facilitators for TEM among professionals and subfertile couples.METHODS: A qualitative study was performed with semi-structured in-depth interviews of 21 subfertile patients who were counselled for TEM and three focus-group interviews of 21 professionals in the field of reproductive medicine. Two theoretical models were used to guide the interviews and the analyses. The primary outcome was the set of identified barriers and facilitators which influence implementation of TEM.RESULTS: Among the subfertile couples, main barriers were a lack of confidence in natural conception, a perception that expectant management is a waste of time, inappropriate expectations prior to the first consultation, misunderstanding the reason for expectant management and overestimation of the success rates of treatment. Both couples and professionals saw the lack of patient information materials as a barrier. Among professionals, limited knowledge about prognostic models leading to a decision in favour of treatment was recognized as a main barrier. A main facilitator mentioned by the professionals was better management of patients' expectations.CONCLUSIONS: We identified several barriers and facilitators which can be addressed to improve the implementation of TEM. These should be taken into account when designing future implementation strategies.",
keywords = "infertility, prognostic models, implementation, barriers , expectant management",
author = "{van den Boogaard}, {N M} and {van den Boogaard}, E and E Bokslag and {van Zwieten}, {M C B} and Hompes, {P G A} and S Bhattacharya and W Nelen and {van der Veen}, F and Mol, {B W J}",
year = "2011",
month = "8",
doi = "10.1093/humrep/der175",
language = "English",
volume = "26",
pages = "2122--2128",
journal = "Human Reproduction",
issn = "0268-1161",
publisher = "OXFORD UNIV PRESS",
number = "8",

}

TY - JOUR

T1 - Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception

AU - van den Boogaard, N M

AU - van den Boogaard, E

AU - Bokslag, E

AU - van Zwieten, M C B

AU - Hompes, P G A

AU - Bhattacharya, S

AU - Nelen, W

AU - van der Veen, F

AU - Mol, B W J

PY - 2011/8

Y1 - 2011/8

N2 - BACKGROUND: European guidelines on fertility care emphasize that subfertile couples should receive information about their chances of a natural conception and should not be exposed to unnecessary treatments and risks. Prognostic models can help to estimate their chances and select couples with a good prognosis for tailored expectant management (TEM). Nevertheless, TEM is not always practiced. The aim of this study was to identify any barriers or facilitators for TEM among professionals and subfertile couples.METHODS: A qualitative study was performed with semi-structured in-depth interviews of 21 subfertile patients who were counselled for TEM and three focus-group interviews of 21 professionals in the field of reproductive medicine. Two theoretical models were used to guide the interviews and the analyses. The primary outcome was the set of identified barriers and facilitators which influence implementation of TEM.RESULTS: Among the subfertile couples, main barriers were a lack of confidence in natural conception, a perception that expectant management is a waste of time, inappropriate expectations prior to the first consultation, misunderstanding the reason for expectant management and overestimation of the success rates of treatment. Both couples and professionals saw the lack of patient information materials as a barrier. Among professionals, limited knowledge about prognostic models leading to a decision in favour of treatment was recognized as a main barrier. A main facilitator mentioned by the professionals was better management of patients' expectations.CONCLUSIONS: We identified several barriers and facilitators which can be addressed to improve the implementation of TEM. These should be taken into account when designing future implementation strategies.

AB - BACKGROUND: European guidelines on fertility care emphasize that subfertile couples should receive information about their chances of a natural conception and should not be exposed to unnecessary treatments and risks. Prognostic models can help to estimate their chances and select couples with a good prognosis for tailored expectant management (TEM). Nevertheless, TEM is not always practiced. The aim of this study was to identify any barriers or facilitators for TEM among professionals and subfertile couples.METHODS: A qualitative study was performed with semi-structured in-depth interviews of 21 subfertile patients who were counselled for TEM and three focus-group interviews of 21 professionals in the field of reproductive medicine. Two theoretical models were used to guide the interviews and the analyses. The primary outcome was the set of identified barriers and facilitators which influence implementation of TEM.RESULTS: Among the subfertile couples, main barriers were a lack of confidence in natural conception, a perception that expectant management is a waste of time, inappropriate expectations prior to the first consultation, misunderstanding the reason for expectant management and overestimation of the success rates of treatment. Both couples and professionals saw the lack of patient information materials as a barrier. Among professionals, limited knowledge about prognostic models leading to a decision in favour of treatment was recognized as a main barrier. A main facilitator mentioned by the professionals was better management of patients' expectations.CONCLUSIONS: We identified several barriers and facilitators which can be addressed to improve the implementation of TEM. These should be taken into account when designing future implementation strategies.

KW - infertility

KW - prognostic models

KW - implementation

KW - barriers

KW - expectant management

U2 - 10.1093/humrep/der175

DO - 10.1093/humrep/der175

M3 - Article

VL - 26

SP - 2122

EP - 2128

JO - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

IS - 8

ER -