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Forewarning
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| Expectations to be managed from the very start |
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‘Success rates based on their own circumstances. So their age her AMH BMIs etc’. P5, Nurse |
| Ways to discuss failure with patients |
Emphasize the chances of failure to be higher than the chance of success early on while remaining cautiously optimistic Frame failure as a learning experience to decide whether and how to adapt next treatment protocol Use neutral language to portray the challenging aspects of treatment Clarify HCPs often cannot be specific about why treatment fails because they do not always know its cause Look at the medical history and personal circumstances of the patient to inform discussion
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‘You need to be realistic and truthful and transparent. But you also need to be using that element of hope that they have’. P5, Nurse ‘It's very, protocol driven, isn't it? Particularly your first cycle, it's very set what they'll do when they start you off. And I think just knowing that if it isn't successful, [staff say] “we'll have a little look and see if we can identify ways we can optimize it now that we've learned more about you”. I think it would be nice to know then it feels a bit more personal to you’. P22, Patient ‘I think not using negative words, even when you portray the negative aspects’. P21, Patient ‘There's a lot that they (consultants) can't answer’. P15, Patient ‘And I think there's a lack of consideration in terms of people's journeys for why they're having treatment. It's kind of like, okay, you signed up to this’. P23, Patient
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| Ways to improve information provision |
Provide factual reliable information from the clinic, not the internet, that can be accessed in the patient’s own time (e.g. information leaflet), to avoid overwhelming the patient during the initial consultation and thoroughly cover the costs of treatment
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‘More information and guidance would always be appreciated because you don't really know how much of what's on the internet is factual’. P19, Patient |
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Collaboration and support
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| Ways to boost collaboration and emotional support |
Consultant believes in the patient, is empathic and makes the patient feel part of a team Ensure continuity of care (i.e. seeing the same staff) Provide empathic support and check-in-calls throughout treatment but particularly at significant stages (e.g. after negative result)
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‘It is important that I have a consultant who […] believes in me and feels part of a team’. P25, Patient ‘So I didn't realize I could do that in my clinic (request to see the same nurse), but I've actually requested to have particular people scan me. So, it's a better, more positive and more supportive situation’. P15, Patient ‘Conversations around emotional sort of wellbeing would have been helpful at the start, before the onset of the treatment’. P24, Patient
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Perseverance with personal treatment plans
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| Ways to boost perseverance with treatment plan |
Discuss realistic treatment timescales Forewarn about factors that could affect planning and treatment success (e.g. ovarian reserve, age, lifestyle), different treatment outcomes, and subsequent options available to patients, including different protocols and treatments available now and likely in future (e.g. IUI, IVF) Use a flowchart of treatment outcomes and options Provide information about the physical, psychological and financial impact of treatment and sources of support and coping techniques (resources list)
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‘If I knew up front that we were talking about this being a couple of years’ worth of a treatment process…’. P18, Patient ‘It would be useful to put things [in the consultation] that can affect the planning. So, things like your ovarian reserve, your age, the potential different protocols’. P12 Consultant. ‘Doing some kind of flowchart to give patients to say that these are the options, so IUI IVF ICSI, in terms of the different journey, the different paths that they could possibly take’. P8, Counsellor ‘A resources list of if you find yourself requiring some emotional support we've got our counselling department or a list of recommended counsellors or BICA or whomever we can refer you, or fertility network. If it's from a financial perspective, then you can speak to our accounts department. Just being upfront and basically providing them with [signposting] if there's something that you've forgotten or want to clarify, then the nursing team or the consultant is available to answer your questions. All of those to make them feel empowered, that they've got the relevant support from all the different areas that could come in’. P7, Counsellor
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