P-563 Efficacy of a brief decisional support intervention on the decision conflict and psychosocial aspects among women with IVF failure: a randomized controlled trial
Authors: Guo D , Chan C H Y , Wang X H 
Published: June 2023

Abstract

Study question
Is decisional support intervention (DSI) efficacious in reducing decisional conflict and improving mental health for women experiencing unsuccessful IVF treatment?

Summary answer
Compared to controls, DSI statistically significantly increased informed decision but not depression symptoms.

What is known already
Failure of IVF treatment could be an unavoidable event and a situation of low control for infertile women. The decisional conflict following unsuccessful IVF treatment could be extremely intense considering the critical issues such as the life goal of childbearing, relationships, finance, etc. Meanwhile, with great importance placed on childbearing, many patients are indulged in the treatment cycles while hesitant to consider ending the treatment or the alternatives, leading to a series of psychosocial problems. Therefore, a decisional support intervention should be considered to facilitate the decision-making and adjustment after unsuccessful IVF treatment.

Study design, size, duration
A multi-centers, two-armed, randomized controlled trial, to assess the efficacy of a decisional support intervention on decisional conflict and psychosocial aspects among women who experienced failure of IVF treatment. Between May 2022 to January 2022, a total of 80 participants were randomly allocated to the DSI group or waitlist control group.

Participants/materials, setting, methods
Eligible participants were women who have undergone at least one cycle of IVF treatment and failed to achieve clinical pregnancy into treatment. DSI participants received a one-hour decisional support counseling, which focused on the discussion about the pros and cons in relation to continuation and termination of treatment, family building alternatives as well as their implications. The participants completed questionnaires before treatment (T0), and after the treatment (T1). Analyses included paired sample t-tests and ANOVA.

Main results and the role of chance
40 subjects in the intervention group and 38 subjects in the control group were included in the intention-to-treat analysis. The between-group effect analysis showed a significant time x group interaction in informed decision (p &lt; 0.05), meaning that informed decision increased in the intervention group but decreased in the control group over time. There was also a marginally significant increase in perceived behavioral control (p = 0.06), as well as a decrease in decisional conflict of uncertainty (p = 0.08) and anxiety symptoms (p = 0.08).

Limitations, reasons for caution
Considering the decision might be navigated by the treatment outcome, this study only measured the short-term effect after the intervention. Secondly, this study only enrolled women, who were more vulnerable to the risk of treatment failures and take a more active role in decision-making, compared to men.

Wider implications of the findings
Instead of putting efforts on psychosocial intervention aiming at improving the chance of pregnancy, this study provides an efficacious brief counseling approach, tapping on patients’ existing cultural values and beliefs, to help patients ‘find the way out’ following the IVF treatment failures.

Trial registration number
ChiCTR2200060238