P-577 Understanding how healthcare professionals address the educational and emotional needs of patients seeking fertility care: an assessment of challenges and barriers across eight countries
Authors: Augustyniak M , Kupka M , Coticchio G , Esteves S , Fincham A , Lazure P , Péloquin S 
Published: June 2023

Abstract

Study question
What are the current challenges and barriers preventing healthcare professionals (HCPs) from optimally addressing patients' educational and emotional needs in fertility care?

Summary answer
HCPs lack optimal knowledge of patients’ needs/preferences for educational and emotional support, have sub-optimal skills addressing them, and underutilize external resources (e.g., psychologists).

What is known already
Couples who have difficulty conceiving a child can face a turmoil of emotions, including anxiety and distress, especially when external social pressures are at play. All patients seeking fertility care deserve their educational and emotional needs to be heard and addressed, as advocated by The European Society of Human Reproduction and Embryology (ESHRE) guidelines. Nevertheless, a 2015 educational and behavioural needs assessment found that HCPs involved in reproductive medicine perceive their skills to identify the needs of patients for psychological and emotional support to be less than optimal, especially when discussing sensitive or distressing issues.

Study design, size, duration
This exploratory mixed-methods study triangulated data from a qualitative phase (76 interviews, June-August 2021) and a quantitative phase (323 surveys, November 2021). Participants included patients (qualitative phase, n = 28), physicians (both phases, n = 249) and laboratory specialists (both phases, n = 122) using assisted reproductive technologies (ART).

Participants/materials, setting, methods
Countries included Brazil, China, France, Germany, Italy, Mexico, Spain, and UK. Interviews were recorded, transcribed and coded. Thematic analyses were performed. Surveys assessed knowledge, skill, agreement, and task performance frequency using 5-point scales. Knowledge and skill ratings of none (1), basic (2) or intermediate (3), as opposed to advanced (4) or expert (5), were considered a gap. Descriptive analysis and crosstabulations with chi-square tests were performed to explore variations by country and professional role/specialty area.

Main results and the role of chance
Patient interviews indicated a need to improve HCPs’ ability to set realistic yet encouraging, expectations about conception outcomes. Underlying barriers to fulfilling this need included a lack of optimal knowledge amongst HCPs regarding patients’ preferences, skills addressing their needs, and an under-utilization of resources for psychological support. Survey results indicated 31-36% of physicians and laboratory specialists had a knowledge gap of patients’ preferences and needs for education and emotional support; 11-39% of physicians had a skill gap for a) educating their patients about factors contributing to couples’ infertility and treatments that can optimize chances of conception/pregnancy; b) setting patient expectations about successful fertility outcomes and next steps; and c) providing emotional support to patients/couples experiencing failure to conceive. For laboratory specialists, 23% reported ‘never’, ‘rarely’ or ‘sometimes’ contributing to patient education. When asked how often they “consult references provided by patient organizations regarding the psychological and emotional needs of patients” and “direct patients to support groups or forums (online or in-person)”, an average of 47-49% of surveyed HCPs said ‘never’, ‘rarely’ or ‘sometimes’. Only 49% of surveyed HCPs reported collaborating with psychologists specialized in infertility. The extent to which gaps affected HCPs varied by country and professional role/specialty area.

Limitations, reasons for caution
Although multiple countries were included in this exploratory mixed-methods study, due to small sample sizes, the likelihood of observing a difference in the frequency of reported challenges, barriers and gaps by country due to chance alone could not be excluded.

Wider implications of the findings
Several years after the publication of the ESHRE guidelines for psychosocial care, challenges related to providing adequate educational and emotional support to patients remain. This study identified opportunities and direction for continuing professional development to promote routine psychosocial care in fertility clinics.

Trial registration number
Not applicable for this mixed-methods self-reported educational needs assessment.