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      Impediments to communication and relationships between infertility care providers and patients

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          Abstract

          Background

          Infertility patients generally see provider-patient communication and relationships as important, but as often insufficient, raising critical questions regarding why these gaps persist, and how they might best be addressed.

          Methods

          Semi-structured interviews of approximately one hour each were conducted with 37 ART providers and patients (17 physicians, 10 other health providers, and 10 patients) and were thematically analyzed.

          Results

          Patients see clinicians’ interactions as ranging widely from good to bad, related to several specific barriers and factors. Patients and providers may differ in their physical and emotional experiences, expectations concerning treatment outcomes and uncertainties, and time frames and finances, generating dynamic processes and tensions. Characteristics of particular providers, clinics and patients can also vary. Infertility patients tend to find only one outcome acceptable – a “take home baby” – rather than partial success, as is the case with many other diseases. Yet most IVF cycles fail. Many patients must pay considerable out-of-pocket expenses for infertility treatment, exacerbating disappointments and frustrations. Providers often work in competitive, entrepreneurial markets, and “hype” their potential success. After treatment failures, providers may feel guilty and withdraw from patients. Yet these behaviors can antagonize patients more than physicians realize, aggravating patient stresses. Several providers described how they understood patients’ needs and perceptions more fully only after becoming infertility patients themselves. Interactions with not only physicians, but other providers (e.g., nurses and staff) can play key roles. Patients may be willing to understand these impediments, but providers often communicate these obstacles and reasons poorly or not at all, furthering tensions.

          Conclusions

          These data, the first to examine several critical aspects of challenges that infertility providers and patients face in communication and relationships, suggest that several key dynamic processes and factors may be involved, and need to be addressed. While prior research has shown that infertility patients value, but often feel disappointed in relationships with clinicians, the present data highlight several specific impediments, and thus have critical implications for future practice, research, guidelines and education.

          Electronic supplementary material

          The online version of this article (10.1186/s12905-018-0572-6) contains supplementary material, which is available to authorized users.

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          Most cited references9

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          Why do couples discontinue in vitro fertilization treatment? A cohort study.

          To investigate reasons for discontinuation of IVF treatment. Prospective, cohort study. Center for reproductive medicine at a large university hospital. The 450 couples of a cohort of 974 couples who started IVF treatment between January 1996 and December 1997 and did not achieve childbirth. The reasons for ceasing treatment were evaluated by scrutinizing the medical records for all couples (n = 288) who did not achieve live birth and who did not complete three stimulated IVF cycles. A questionnaire was sent to all patients for whom the reason for discontinuation was not obvious from the medical records (n = 211). Reasons for discontinuing IVF. Of 450 couples not achieving live birth, 208 completed their subsidized cycles, whereas 242 discontinued IVF. In 192 (79%) of the 242 cases, the reasons for ceasing treatment could be identified from records or questionnaires. The reason for discontinuation was psychological burden in 26%, a poor prognosis in 25%, spontaneous pregnancy in 19%, physical burden in 6%, serious disease in 2%, and other reasons in 7%. An unexpectedly high percentage of couples who performed IVF discontinued the treatment before the three cycles that were offered to a majority of the couples. A majority of these discontinuations were due to psychological stress. This information is of importance when counseling patients during treatment.
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            Improving education on doctor-patient relationships and communication: lessons from doctors who become patients.

            Medical education faces challenges in training empathetic doctors who have good patient communication skills. The author aimed to understand insights that doctors who become patients may gain concerning ways to improve doctor-patient relationships and communication in order to improve medical education.
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              Stigma: the hidden burden of infertility.

              Infertility is experienced by 5 million U.S. couples, some of whom perceive it a stigmatizing condition. Recent technological innovations have created a multitude of medical interventions for those infertile individuals who can financially afford them. For some infertile women, those interventions also transform infertility from a private pain to a public, prolonged crisis. Our research focuses on 25 U.S. women who sought medical treatment for infertility and describes their perception of the stigma associated with infertility. We apply a critical, feminist perspective to our analysis of the women's lived experiences within the social and medical contexts in which they occur.
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                Author and article information

                Contributors
                646-774-6912 , rlk2@cumc.columbia.edu
                Journal
                BMC Womens Health
                BMC Womens Health
                BMC Women's Health
                BioMed Central (London )
                1472-6874
                5 June 2018
                5 June 2018
                2018
                : 18
                : 84
                Affiliations
                ISNI 0000000419368729, GRID grid.21729.3f, Columbia University, ; 1051 Riverside Drive #15, New York, NY 10032 USA
                Author information
                http://orcid.org/0000-0002-6827-8063
                Article
                572
                10.1186/s12905-018-0572-6
                5989459
                29871622
                b4115d41-226b-495b-bd3c-49b1854c5c55
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 October 2016
                : 21 May 2018
                Funding
                Funded by: the National Center for Research Resources
                Award ID: UL1 RR024156
                Award Recipient :
                Funded by: The Greenwall Foundation
                Funded by: The John Simon Guggenheim Foundation
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Obstetrics & Gynecology
                provider-patient relationships,provider-patient communication,infertility treatment,fertilization,in vitro,ethics,policy,education,medical,empathy,patient-centered care

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