Feasibility and acceptability of psychosocial care for unsuccessful fertility treatment

Abstract

Introduction: Many people undergo fertility treatment to have biological children, but around four in ten patients complete all treatment cycles without having the children they desire. This triggers intense grief from which patients report taking on average 2 years to recover. Fertility guidelines and regulators stress the need to support patients through this process, but there is a scarcity of evaluated interventions to this end and evidence about when and how to offer care is lacking. This study explored patients' and healthcare professionals' (HCPs) experiences of and views about provision of psychosocial care (to patients facing unsuccessful fertility treatment, i.e., care provided by a mental health professional to address the emotional, cognitive, behavioural, relational and social needs that patients have at this stage of treatment).Methods: Five qualitative online focus groups were conducted with Portuguese participants: three with patients waiting to initiate or undergoing their last cycle of in vitro fertilization/intracytoplasmic sperm injection or having completed it within the last 2 months without achieving a pregnancy and two with HCPs working at fertility clinics. Focus groups were recorded and transcribed verbatim, and data were analysed with Framework Analysis.Results: Thirteen patients and nine HCPs participated. Analysis resulted in 1293 codes, systematically organized into 13 categories, 4 themes and 1 metatheme. The latter showed high consensus about the need for psychosocial care for unsuccessful treatment, but perceived challenges in its implementation. Themes reflected (1) consensual demand for psychosocial care at all stages of treatment but particularly at the end, (2) high perceived acceptability of integrating preventive care initiated during treatment with early psychosocial care only for those patients who experience unsuccessful treatment, (3) perceived challenges of implementing

Discussing the possibility of fertility treatment being unsuccessful as part of routine care offered at clinics: patients’ experiences, willingness, and preferences

“…Some have suggested elsewhere that integrating multiple-cycle panning with PCUFT could help prevent decisional conflict about ending treatment ( Harrison et al , 2022 ). Furthermore, HCPs should be aware that around two in 10 patients only feel prepared to receive PCUFT after one unsuccessful cycle or at later stages of treatment, as these patients might have more serious concerns about PCUFT impacting their engagement with treatment ( Sousa-Leite et al , 2022 ). Finally, around one in 10 patients do not want to engage in PCUFT, which should be respected.…”

“…PCUFT can also be costly for HCPs, as discussions about health-related ‘bad news’ are known to be taxing ( Boivin et al , 2017 ). Although most HCPs consider discussions about the possibility of treatment being unsuccessful imperative ( Sousa-Leite et al , 2022 ), many fear that addressing this possibility may trigger negative performance evaluations from patients ( Fedele et al , 2020 ). Addressing this topic may also trigger feelings of frustration and powerlessness in HCPs, who may feel responsible for the treatment outcome, as well as the weight of responsibility of potentially influencing such an important patient decision ( Meier et al , 2001 ; Fedele et al , 2020 ).…”

Fertility clinics have a duty of care towards patients who do not have children with treatment

“…Healthcare professionals (HCPs) often express concerns about discussing negative treatment outcomes with patients because they do not want to be perceived as unsupportive or discouraging, nor drive patients away from the clinic ( Harrison et al , 2022 ). Similarly, most patients think hope and optimism are important and that too much negativity before treatment starts is not appropriate ( Harrison et al , 2022 ; Sousa-Leite et al , 2022 ). While patients foregoing treatment based on proper information on all possible outcomes is not problematic, and in fact preferable to patients only pursuing treatment because they are ill-informed, the fear that patients may not pursue treatment because they do not feel supported is a valid concern.…”