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Kaptein AA, Harper JC, Dool GVD, Schoonenberg M, Smeenk J, Daneshpour H, Troost M, van Wijk LM, Tielen N, Smit E, Laven J, Hoek A, Boivin J. Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs. Reprod Biomed Online 2024; 49:104113. [PMID: 39043044 DOI: 10.1016/j.rbmo.2024.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 07/25/2024]
Abstract
RESEARCH QUESTION From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention? DESIGN Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. RESULTS Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study. CONCLUSIONS The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.
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Affiliation(s)
- Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Joyce C Harper
- UCL Institute for Women's Health, 86-96 Chenies Mews, London, England WC1E 6HX, UK
| | | | | | - Jesper Smeenk
- Center for Reproduction Brabant - Gynaecology, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Hirad Daneshpour
- KPMG Health, Laan van Langerhuize 1, 1186 DS Amstelveen, The Netherlands
| | - Meike Troost
- KPMG Health, Laan van Langerhuize 1, 1186 DS Amstelveen, The Netherlands
| | - Lise M van Wijk
- Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands
| | - Naomi Tielen
- Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands
| | - Ellen Smit
- Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands
| | - Joop Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 30001, 9700 RB Groningen, The Netherlands
| | - Jacky Boivin
- School of Psychology, Cardiff University, 70 Park Place, Cardiff, Wales, CF10 3AT, UK.
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Gameiro S, Leone D, Mertes H. Fertility clinics have a duty of care towards patients who do not have children with treatment. Hum Reprod 2024; 39:1591-1598. [PMID: 38890127 PMCID: PMC11291940 DOI: 10.1093/humrep/deae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/06/2024] [Indexed: 06/20/2024] Open
Abstract
In medically assisted reproduction (MAR) success has mostly been measured in terms of achieving (healthy) livebirths. We argue this focus is too narrow and that success should be measured in terms of alleviating patient suffering caused by an unfulfilled child wish. The major implication is that clinics must better tailored care to effectively support patients who do not have child(ren) with treatment. First, we argue that clinics have a duty of care towards patients for whom MAR does not result in children because this is a common treatment outcome, because treatment is burdensome and creates new losses for patients, and because the field has the necessary expertise to provide support and it is part of patient-centred care. Then, we examine concerns about the adequacy of addressing the possibility that treatment may end without children, namely, that this may hinder patients' hope and put them off doing treatment, and that it may be perceived as a sign of clinical incompetence, as well as concerns about the required skill set. We end with a set of research-informed recommendations to promote healthy adjustment to ending fertility treatment without children. These focus on the need to reconceptualize 'success' and 'failure' in MAR, to promote open discussion about the possibility of treatment not resulting in children and encourage patients to develop 'plan(s) B', to support patients who end treatment without children, and to create the organizational structures needed to support clinics and healthcare professionals in this endeavour.
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Affiliation(s)
- S Gameiro
- School of Psychology, Cardiff University, Cardiff, UK
| | - D Leone
- Unit of Clinical Psychology, San Paolo University Hospital, Milan, Italy
| | - H Mertes
- Department of Philosophy and Moral Sciences, Ghent University, Gent, Belgium
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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Petra T, Wischmann T, Mayer-Lewis B. Evaluation of infertility counselling in Germany. Arch Gynecol Obstet 2024; 309:1065-1073. [PMID: 38172455 DOI: 10.1007/s00404-023-07316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This paper reports on the first evaluation of infertility counselling in Germany. METHODS Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients. RESULTS The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects. CONCLUSIONS This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts.
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Affiliation(s)
- Thorn Petra
- Praxis für Paar- und Familientherapie, Langener Strasse 37, 64546, Moerfelden, Germany.
| | - Tewes Wischmann
- Institute of Medical Psychology, University Hospital Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Birgit Mayer-Lewis
- Lutheran University of Applied Sciences-Evangelische Hochschule Nürnberg, Bärenschanzstraße 4, 90429, Nuremberg, Germany
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Woodward JT, Cirino NH, Copland S, Davoudian T. Integrated Behavioral Health Care in Reproductive Medicine: How and Why to Include Mental Health Professionals in Infertility Care Teams. Clin Obstet Gynecol 2024; 67:222-232. [PMID: 38146084 DOI: 10.1097/grf.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Despite fertility patients' reports of significant distress, few have access to integrated mental health care services. We elucidate the benefits and challenges of mental health integration in infertility practices from the perspective of both patients and providers. We outline specific models of integration, financial viability, and the first steps fertility clinics could take to improve their patients' access to these critical supports.
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Affiliation(s)
| | - Nicole H Cirino
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Texas Children's Hospital, Pavilion for Women, Houston, Texas
| | - Susannah Copland
- Atlantic Reproductive Medicine Specialists, Raleigh, North Carolina
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Scaravelli G, Fedele F, Spoletini R, Monaco S, Renzi A, Di Trani M. Toward a Personalized Psychological Counseling Service in Assisted Reproductive Technology Centers: A Qualitative Analysis of Couples' Needs. J Pers Med 2022; 13:jpm13010073. [PMID: 36675734 PMCID: PMC9867277 DOI: 10.3390/jpm13010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Infertility may have a very strong emotional impact on individuals, requiring adequate support, but few studies on patients' demands toward psychological support have been conducted. This study aims to explore the emotions related to the infertility and to the Assisted Reproductive Technology (ART) procedure for which patients consider useful a psychological support. A total of 324 women completed a sociodemographic and clinical questionnaire and an open-ended questionnaire on emotional needs for psychological support. The written texts were explored by the Linguistic Inquiry and Word Count (LIWC) programme and linguistic characteristics were related to sociodemographic and anamnestic variables. Specific linguistic features were connected to several individual characteristics. More specifically, differences in linguistic processes emerged comparing women with an age over or under 40 years, women undergoing their first attempts versus more attempts, women undergoing ART with or without gamete donation, and women undergoing ART for male or unknown causes, as well as those undergoing ART for female or both partners' problems. These differences seem to confirm that older age, more attempts, gamete donation, and ART for unknown or male causes are risk factors that may worsen women's psychological well-being. This study contributes to increase the knowledge about the emotional needs of patients undergoing an ART procedure to develop specific psychological intervention programs.
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Affiliation(s)
- Giulia Scaravelli
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fabiola Fedele
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy
| | - Roberta Spoletini
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy
| | - Silvia Monaco
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy
- Correspondence:
| | - Alessia Renzi
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy
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Thomson N, McIlwaine K. Assisted reproductive… training. Emerg Med Australas 2022; 34:1012-1014. [DOI: 10.1111/1742-6723.14118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Natasha Thomson
- Paediatric Intensive Care Unit, Monash Medical Centre Melbourne Victoria Australia
| | - Kate McIlwaine
- Genea Fertility and Mercy Hospital for Women Melbourne Victoria Australia
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Riddle MP. Assuring provision of mental health care to the most vulnerable patients: a renewed call for integrative care. Fertil Steril 2022; 117:1309-1310. [PMID: 35525816 DOI: 10.1016/j.fertnstert.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mary P Riddle
- Department of Psychology, The Pennsylvania University, State College, Pennsylvania
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