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Foggin H, Metcalfe R, Hutcheon JA, Bansback N, Burrows J, Karacebeyli E, Shivananda S, Boutin A, Liauw J. Understanding what patients and physicians need to improve their decision-making about antenatal corticosteroids in late preterm gestation: a qualitative framework analysis. CMAJ Open 2023; 11:E466-E474. [PMID: 37220957 DOI: 10.9778/cmajo.20220139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND It is unclear whether the benefits of administration of antenatal corticosteroids in late preterm gestation outweigh its harms. We sought to understand whether patients and physicians need increased support to decide whether to administer antenatal corticosteroids in late preterm gestation, and their informational needs and preferences for decision-making roles related to this intervention; we also wanted to know if creation of a decision-support tool would be useful. METHODS We conducted individual, semistructured interviews with pregnant people, obstetricians and pediatricians in Vancouver, Canada, in 2019. Using a qualitative framework analysis method, we coded, charted and interpreted interview transcripts into categories that formed an analytical framework. RESULTS We included 20 pregnant participants, 10 obstetricians and 10 pediatricians. We organized codes into the following categories: informational needs to decide whether to administer antenatal corticosteroids; preferences for decision-making roles regarding this treatment; the need for support to make this treatment decision; and the preferred format and content of a decision-support tool. Pregnant participants wanted to be involved in decision-making about antenatal corticosteroids in late preterm gestation. They wanted information on the medication, respiratory distress, hypoglycemia, parent-neonate bonding and long-term neurodevelopment. There was variation in physician counselling practices, and in how patients and physicians perceived the balance of treatment harms and benefits. Responses suggested a decision-support tool may be useful. Participants desired clear descriptions of risk magnitude and uncertainty. INTERPRETATION Pregnant people and physicians would likely benefit from increased support to consider the harms and benefits of antenatal corticosteroids in late preterm gestation. Creation of a decision-support tool may be useful.
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Affiliation(s)
- Hannah Foggin
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Rebecca Metcalfe
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Nick Bansback
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jason Burrows
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Eda Karacebeyli
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Sandesh Shivananda
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Amelie Boutin
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jessica Liauw
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
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Mackay A, Taylor S, Glass B. Inequity of Access: Scoping the Barriers to Assisted Reproductive Technologies. PHARMACY 2023; 11:pharmacy11010017. [PMID: 36649027 PMCID: PMC9887590 DOI: 10.3390/pharmacy11010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Infertility impacts millions of people of reproductive age worldwide, with approximately 10-15% of couples affected. When infertility is present, there are many potential barriers to treatment, leading to inequity of access. Assisted reproductive technologies (ART) are the mainstay of medical treatment for infertility and include procedures such as in vitro fertilisation. This scoping review aims to explore the barriers to accessing assisted reproductive technologies to highlight a potential role for the pharmacist in addressing these barriers. Five databases, including CINAHL, Emcare, Medline, Scopus, and Web of Science, were searched using keywords that resulted in 19 studies that explored barriers to initially accessing or continuing ART. Studies identified more than one barrier to accessing ART, with the most mentioned barrier being the geographic location of the patient, with others themed as psychological, financial, minority groups, educational level, and the age of the patient. Recommendations were made to address barriers to accessing ART, which included changes to government regulations to increase health education and promotion of infertility. Pharmacists' accessibility, even in geographically remote locations, places them in an ideal position to address many of the challenges experienced by people accessing infertility treatment to improve outcomes for these people.
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Affiliation(s)
- Amanda Mackay
- Pharmacy, College of Medicine and Dentistry, James Cook University, Douglas, Townsville, QLD 4811, Australia
- Correspondence:
| | - Selina Taylor
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD 4825, Australia
| | - Beverley Glass
- Pharmacy, College of Medicine and Dentistry, James Cook University, Douglas, Townsville, QLD 4811, Australia
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Nesbit CB, Blanchette-Porter M, Esfandiari N. Ovulation induction and intrauterine insemination in women of advanced reproductive age: a systematic review of the literature. J Assist Reprod Genet 2022; 39:1445-1491. [PMID: 35731321 PMCID: PMC9365895 DOI: 10.1007/s10815-022-02551-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The objective of this review is to define live birth rate (LBR) and clinical pregnancy rate (CPR) for women ≥ 40 undergoing ovulation induction (OI)/intrauterine insemination (IUI). METHODS A systematic review was performed in accordance with PRISMA guidelines using PubMed and Google Scholar. The primary and secondary outcomes of interest were LBR and CPR, respectively. RESULTS There were 636 studies screened of which 42 were included. In 8 studies which provided LBR for partner sperm, LBR/cycle ranged from 0 to 8.5% with majority being ≤ 4%. Cumulative LBR was 3.6 to 7.1% over 6 cycles with the majority of pregnancies in the first 4. In the four studies providing LBR for donor sperm cycles, LBR/cycle ranged from 3 to 7% with cumulative LBR of 12 to 24% over 6 cycles. The majority of pregnancies occurred in the first 6 cycles. There were three studies with LBR or CPR/cycle ≥ 1% for women ≥ 43. No studies provided data above this range for women ≥ 45. In 4 studies which compared OI/IUI and IVF, the LBR from IVF was 9.2 to 22% per cycle. In 7 studies which compared outcomes by stimulation protocol, no significant differences were seen. CONCLUSION For women ≥ 40 using homologous sperm, the highest probability of live birth is via IVF. However, if IVF is not an option, OI/IUI may be considered for up to 4 cycles in those using partner sperm or 6 cycles with donor sperm. For women > 45, OI/IUI is likely futile but a limited trial may be considered for psychological benefit while encouraging consideration of donor oocyte IVF or adoption. Use of gonadotropins does not appear to be more effective than oral agents in this age group.
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Affiliation(s)
- Carleigh B Nesbit
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
- The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Misty Blanchette-Porter
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
- The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA
| | - Navid Esfandiari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA.
- The Robert Larner College of Medicine at the University of Vermont, Burlington, VT, 05405, USA.
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