'What if we never make it!? What's going to happen to us?': Routine psychosocial care to promote patients' adjustment to the end of unsuccessful fertility treatment

Sousa Leite, Mariana ORCID: https://orcid.org/0000-0002-8002-4648 2024. 'What if we never make it!? What's going to happen to us?': Routine psychosocial care to promote patients' adjustment to the end of unsuccessful fertility treatment. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Around four in every ten people undergoing in vitro fertilisation (IVF) end treatment without a live birth - referred to as end of unsuccessful fertility treatment (EoT). There is a lack of accessible, evidence-based care to support these patients. The present thesis aimed to develop and evaluate psychosocial care initiatives to promote patients’ adjustment to EoT, including preventive (i.e., to inform and prepare patients for EoT) and early intervention (i.e., to support patients in the aftermath of EoT) care. The work followed the Medical Research Council (MRC) framework to develop complex interventions. A cross-sectional mixed-methods online survey investigated patients’ willingness and preferences to receive EoT psychosocial care. Cross-sectional focus groups, a prospective pilot feasibility single-arm trial, and a definitive registered (ISRCTN85897617) multicentre RCT, evaluated the acceptability, feasibility and efficacy of Beyond Fertility: a brief face-to-face psychosocial intervention integrating EoT preventive and early intervention care. Cross-sectional multi-country focus groups with stakeholders’ involvement evaluated the acceptability and feasibility of multi-lingual web-based educational resources to promote the routine implementation of EoT preventive care at fertility clinics. Results showed stakeholders’ high acceptability and demand for routine EoT psychosocial care at clinics; patients’ high willingness to receive EoT preventive care early in treatment, but staff’s concerns about its adequacy; Beyond Fertility was considered needed and acceptable; RCT-modified intention to treat analysis revealed Beyond Fertility was not efficacious in ameliorating declines in quality of life (primary outcome), mental health and well-being (secondary outcomes); Implementation practicalities regarding identifying iii patients reaching the treatment ends; web-based resources were considered highly needed and adequate (now freely accessible for public use). Findings suggest a need for a normative change in fertility clinics towards the routine implementation of EoT preventive and early intervention care, providing foundational knowledge about the acceptability, feasibility and efficacy of its content, time and delivery mode. Keywords: Assisted reproductive technology, IVF, end of unsuccessful fertility treatment, intervention development and evaluation, preventive care, early intervention care, quality of life, mental health, well-being.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Date of First Compliant Deposit:	10 May 2024
Last Modified:	10 May 2024 12:46
URI:	https://orca.cardiff.ac.uk/id/eprint/168829

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