ABSTRACT
BACKGROUND: The aim of this study was to investigate to what extent patients' experiences with fertility care are associated with their quality of life (QoL), and levels of anxiety and depression. METHODS: We performed a cross-sectional questionnaire study within 29 Dutch fertility clinics, including women with fertility problems. Through multilevel regression analyses, associations between patients' QoL (FertiQoL) and distress [anxiety and depression; Hospital Anxiety and Depression Scale (HADS)] and their experiences with fertility care [patient-centredness questionnaire (PCQ)-infertility] were determined. For all multilevel models, R² and intra-cluster correlation coefficients were calculated. RESULTS: This study included 427 non-pregnant patients who filled out the FertiQoL, HADS and PCQ-infertility (response rate 76%). Multilevel regression analysis showed significant associations between the PCQ total scale, the total FertiQoL scale (B = 0.25), and HADS subscales (B = -0.22 and -0.18). Of the variance in patients' experiences, 13% (=R²) could be explained by their perceived QoL, 12% by their level of anxiety and 10% by their level of depression. CONCLUSIONS: Patient-centredness in fertility care and the patients' QoL and anxiety and depression scores are related. Paying attention to these variables could lead to positive care experiences and improved patient-centredness of care. Future research should focus on identifying causal relationships among these variables.
Subject(s)
Anxiety/etiology , Depression/etiology , Infertility, Female/psychology , Infertility, Female/therapy , Precision Medicine , Quality of Life , Reproductive Techniques, Assisted/adverse effects , Adult , Ambulatory Care Facilities , Attitude to Health , Cross-Sectional Studies , Female , Humans , Middle Aged , Netherlands/epidemiology , Psychiatric Status Rating Scales , Reproductive Behavior , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND: Patient-centredness is one of the core dimensions of quality of care. It can be monitored with surveys measuring patients' experiences with care. The objective of the present study was to determine to what extent gynaecologists, physicians specializing in infertility and nurses can estimate the level of patient-centredness of their clinic. METHODS: A random sample of 1189 couples with fertility problems and 194 physicians and nurses from 29 Dutch fertility clinics participated in this cross-sectional study. Differences between patients' experiences with fertility care and professionals' perceptions of these experiences as measured with the patient-centredness questionnaire-infertility (PCQ-infertility) were calculated. The questionnaire's structure, comprising one total scale (level 1), seven subscales (level 2) and 46 single items (level 3), was used as a framework. RESULTS: Response rates were 75% (n = 888) in the patient sample and 83% (n = 160) in the professional sample. Independent sample t-tests, corrected for multiple comparisons with the Bonferroni correction method (P < 0.05), showed no significant differences in mean scores on the total scale of patient-centredness for either professionals or patients. At level 2, professionals underestimated most subscales, namely, 'Accessibility', 'Communication', 'Patient involvement' and 'Competence', whereas 'Continuity of care' was overestimated. Professionals significantly and clinically relevantly misjudged 29 care aspects. CONCLUSIONS: Professionals within fertility care cannot adequately evaluate their performance regarding patient-centredness, and specifically the care aspects to which their own patients attribute the greatest improvement potential. Providing detailed feedback might start improvement of patient-centredness and quality of care.
Subject(s)
Attitude of Health Personnel , Patient Satisfaction , Reproductive Techniques, Assisted/psychology , Social Perception , Adult , Cross-Sectional Studies , Female , Humans , Infertility/therapy , Male , Middle Aged , Patient-Centered Care , Quality of Health CareABSTRACT
BACKGROUND: This study examined the relationship between emotional distress as measured by the Hospital Anxiety and Depression Scale (HADS) and the Fertility Quality of Life (FertiQoL) questionnaire. METHODS: The FertiQoL and HADS were distributed to a random sample of 785 patients attending 29 Dutch clinics for medically assisted reproduction. FertiQoL was psychometrically tested for reliability. Pearson's correlations were calculated between subscales of FertiQoL and HADS. Using an independent t-test, differences between patient subgroups were computed for both instruments. The threshold for clinically meaningful depression/anxiety on the HADS subscales was used to ascertain the critical threshold for high distress on the FertiQoL scales. RESULTS: FertiQoL and HADS were completed by 583 patients (response 74%). Reliability of FertiQoL scales was high (reliability coefficient between 0.72 and 0.91). Significant negative correlations were found between FertiQoL subscales and HADS scores for anxiety and depression, ranging from -0.29 to -0.71. Means on FertiQoL scales and HADS scales of couples undergoing an assisted reproductive technology (ART) treatment and a non-ART treatment did not differ significantly. Patients scoring above the HADS threshold for pathology on anxiety had an average FertiQoL score of 58.8, whereas patients exceeding the HADS depression threshold had a FertiQoL total score of 51.9 (range 0-100). CONCLUSIONS: Our study confirms the expected negative relation between quality of life as measured by FertiQoL and anxiety and depression. The data support that FertiQoL reliably measures QoL in women facing infertility. FertiQoL enables clinicians to tailor care more specifically to the patient in a comprehensive way.
Subject(s)
Infertility, Female/psychology , Quality of Life/psychology , Adult , Anxiety/epidemiology , Depression/epidemiology , Female , Humans , Infertility, Female/therapy , Psychometrics , Reproductive Techniques, Assisted/psychologyABSTRACT
BACKGROUND High-quality care for patients faced with infertility should be patient-centred. Few studies have provided in-depth insights into the patient's perspective on care and, to the best of our knowledge, no study has provided a model of the complex concept 'patient-centred infertility care'. Therefore, a qualitative study aimed at understanding 'patient-centred infertility care' from the patient's perspective was conducted. METHODS Fourteen focus group discussions were organized with patients (n = 103) from two European countries to find out about patients' positive and negative experiences with infertility care. Content analysis of the transcripts and analysis of patients' priority lists were conducted. RESULTS The patient-centredness of infertility care depends on 10 detailed dimensions, which can be divided into system and human factors, and there is a two-way interaction between both kinds of factors. System factors, in order of patient's priority, are: provision of information, competence of clinic and staff, coordination and integration, accessibility, continuity and transition and physical comfort. Human factors, in order of patient's priority, are: attitude of and relationship with staff, communication, patient involvement and privacy and emotional support. CONCLUSIONS This study provides a detailed patient's description of the concept 'patient-centred infertility care' and an interaction model that aids understanding of the concept. Fertility clinics are encouraged to improve the patient-centredness of their care by taking into account the detailed description of the dimensions of patient-centred infertility care, and by paying attention to both system and human factors and their interaction when setting up 'patient-centred improvement projects'.