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Hum. Reprod. Advance Access published online on October 27, 2009
Human Reproduction, doi:10.1093/humrep/dep362
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Weaknesses, strengths and needs in fertility care according to patients

Inge W.H. van Empel1,4, Willianne L.D.M. Nelen1, Eveline T. Tepe2, Esther A.P. van Laarhoven1, Christianne M. Verhaak3 and Jan A.M. Kremer1

1 Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands 2 Department of Obstetrics and Gynaecology, Slingeland Hospital, Doetinchem, The Netherlands 3 Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

4 Correspondence address. E-mail: i.vanempel{at}obgyn.umcn.nl

BACKGROUND: The patients' role in assessing health care quality is increasingly recognized. Measuring patients' specific experiences and needs generates concrete information for care improvement, whereas satisfaction surveys only give an overoptimistic, undifferentiating picture. Therefore, this study aimed to investigate possible weaknesses, strengths and needs in fertility care by measuring patients' specific experiences.

METHODS: Mixed (qualitative and quantitative) methods were used to identify weaknesses, strengths and needs in fertility care. Four focus groups with 21 infertile patients were used for documenting care aspects relevant to patients. The fully transcribed qualitative results were analysed and converted into a 124-item questionnaire, to investigate whether these aspects were regarded as weaknesses, strengths or needs in fertility care. The questionnaire was distributed to 369 eligible couples attending 13 Dutch fertility clinics. Descriptive statistics were used to determine the quantity of the weaknesses, strengths and needs.

RESULTS: Overall, 286 women (78%) and 280 men (76%) completed the questionnaire. Patients experienced many weaknesses in fertility care, mostly regarding emotional support and continuity of care. Respect and autonomy and partner involvement were considered strengths in current care. Furthermore, women expressed their need for more doctors' continuity during their treatment, and couples strongly desired to have free access to their own medical record. The questionnaire's internal consistency and construct validity were sufficient.

CONCLUSIONS: Infertile couples experience strengths, but also many weaknesses and needs in current fertility care. Lack of patient centredness seems to be a major cause herein. Using mixed methods is a sensitive means for identifying these weaknesses and needs.

Key words: fertility care/focus groups/health care survey/patient experiences/needs assessment

Submitted on April 22, 2009; resubmitted on September 14, 2009; accepted on September 16, 2009.


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