Addyman, G., Waters, C.  ORCID: https://orcid.org/0000-0002-7049-9906, Gameiro, S. ORCID: https://orcid.org/0000-0003-2496-2004 and Copeland, L.
2026.
L26/P-570 Co-design of best practice recommendations for trauma-informed provision of fertility care: a modified Delphi study [Abstract].
Human Reproduction
41
(S1)
, deag083.903.
10.1093/humrep/deag083.903
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Abstract
Study question What consensus-based recommendations do fertility stakeholders identify as important for delivering trauma-informed fertility care in UK clinical settings? Summary answer Focus groups with fertility stakeholders generated 125 recommendations. Consensus supported inclusion of 101 recommendations, spanning six trauma-informed principles and additional fertility-specific domains. What is known already Ninety percent of adults report at least one traumatic experience and 8% develop post-traumatic stress disorder (PTSD), with women twice as likely as men to experience PTSD. Infertility and fertility treatment are widely recognized as stressful, yet their potential to be experienced as traumatic is underexplored. Common events in fertility care, including (recurrent) miscarriage, may elicit trauma and evidence suggests trauma symptoms may arise across the fertility journey. Trauma remains poorly recognized, prompting calls for trauma-informed fertility care. Trauma informed principles include safety; trustworthiness and transparency; collaboration and mutuality; peer support; empowerment, voice and choice; and cultural and historical considerations. Study design, size, duration An online modified Delphi study—an iterative, consensus-building method using rounds of structured feedback—was conducted over five months. Dissemination was supported by the charity Fertility Network UK. Participant inclusion criteria were being an adult, having personal and/or professional knowledge of fertility care, and ability to read/write English. An advisory board of four fertility professionals and patient advocates, one of whom had patient experience, was consulted regarding design, analysis, results interpretation, and refinement of final recommendations. Participants/materials, setting, methods Online semi-structured focus groups and individual meetings invited participants to generate recommendations reflecting the six trauma-informed principles and fertility-specific experiences. Transcripts were analysed using unconstrained deductive content analysis (Elo & Kyngäs, 2008) to generate candidate recommendations. One transcript was dual-coded to assess coding reliability. After, participants rated each recommendation’s importance using a 1–7 Likert scale. Consensus for inclusion was defined as ≥ 80% agreement. Items not reaching consensus were re-rated in subsequent rounds (up to four). Main results and the role of chance Thirty-eight people consented to participate, representing diverse professional roles and lived experience of fertility care. Thirty-two (88.89%) participated in five focus groups and four (11.11%) in individual meetings. Inter-rater reliability was Krippendorf’s α = 0.71. Analysis generated 125 candidate recommendations, spanning all six trauma-informed principles (25 safety; 15 trustworthiness and transparency; 12 collaboration and mutuality; 8 peer support; 12 empowerment, voice and choice; and 23 cultural and historical considerations) and two additional emergent themes were availability and cost of counselling/therapy (3 recommendations), and trauma-informed staff training, supervision, and support (3 recommendations). Delphi response rates were Round 1 = 94.69%, Round 2 = 94.69%, Round 3 = 86.49%, Round 4 = 89.19%. Consensus was reached on inclusion of 100 recommendations and exclusion of five in Round 1. A further one recommendation was included and 11 excluded in Round 2, five excluded in Round 3, and one excluded in Round 4. In total, 101 recommendations reached consensus for inclusion, 22 for exclusion. Two did not reach consensus and were excluded. An example recommendation is: ‘Intake questionnaires should include questions about fertility-related trauma, such as previous IVF cycles or other treatments and experiences of pregnancy or baby loss, to better understand patients’ histories and needs.’ Limitations, reasons for caution Findings should be interpreted considering the relatively small, UK-based Delphi panel and potential self-selection of participants with interest in trauma-informed care, although attrition was minimal. Analysis was reliable but results not generalizable to global-majority populations, which were under-represented. Recommendations assessed importance, not feasibility, and perceived prescriptiveness may have influenced consensus. Wider implications of the findings The breadth of consensus-based recommendations highlights substantial unmet need for trauma-informed guidance in fertility care. These recommendations provide a stakeholder consensus-based framework for clinics to improve environments, communication, and systems through staff training and service development. Future research should examine feasibility, prioritisation, and implementation across diverse fertility settings.
| Item Type: | Short Communication |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Schools > Psychology |
| Publisher: | Oxford University Press |
| ISSN: | 0268-1161 |
| Last Modified: | 20 Jul 2026 11:31 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/188329 |
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