Development and evaluation of educational intervention to promote informed decision making regarding embryo transfer in IVF patients

Rai, Vibha (2012) Development and evaluation of educational intervention to promote informed decision making regarding embryo transfer in IVF patients. PhD thesis, University of Nottingham.

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Abstract

Increasing the uptake of elective single embryo transfer is necessary to achieve the 10% HFEA limit for multiple IVF births in 2011. This thesis aims to explore patients’ and clinicians’ attitudes to eSET and to promote effective decision making regarding embryo transfer.

Study 1 compared neurobehavioural outcomes between twins and singletons in a prospective study of infants born very preterm (n=233). Despite having older (p=0.025) and higher social class (p=0.023) mothers, twins had the same risk of cognitive impairment at 2 years as singletons.

In study 2, a 44 item Attitudes to Twin Pregnancy scale (ATIPS) was developed and administered to a sample of clinicians, medical students and conference delegates (n=411). Item analysis reduced ATIPS to 2 short subscales. A-Twin (12 items) assessed perceptions of risks and benefits associated with a twin birth (α=0.7). A-SET (8 items) assessed attitudes to eSET (α=0.53).

Study 3 explored the reliability and validity of ATIPS-R in IVF patients. Exclusion of 2 A-SET items increased alpha to 0.8. Female patients (n=100) had more positive attitudes to a twin birth than clinicians (p=<0.001). Less than a third of patients felt that a twin birth was risky for infants and over 80% of doctors agreed that a twin birth was worth any risks to infants. First cycle IVF patients were more positive about eSET (p=<0.001) than women undergoing repeat cycles.

Study-4 developed a decision aid and evaluated its impact in a pilot randomised controlled trial (n=8). Lower decisional conflict in patients at embryo transfer was associated with more positive attitudes to twins at baseline (p=0.024) and less positive attitudes to eSET, (p=0.04). Although the attitudes of patients receiving the DA did not change, partners became more positive towards eSET (p=0.024).

Conclusion: Patients and clinicians underestimate the risk of a twin birth for infants and would benefit from educational interventions to promote eSET. The ATIPS-R is a useful measure for assessing the effectiveness of such interventions.

Abbreviations: SET- single embryo transfer; HFEA- Human fertility and embryology authority; IVF- In vitro fertilisation; A-Twin- attitude to risks and benefits of twins; ATIP- attitude to twin IVF pregnancy; A-SET attitude to single embryo transfer; eSET- elective single embryo transfer; DET- double embryo transfer; RCT – randomised control trial; DA- decision aid

Item Type:Thesis (PhD)
Supervisors:Glazebrook, C.
Faculties/Schools:UK Campuses > Faculty of Medicine and Health Sciences > School of Community Health Sciences
ID Code:2683
Deposited By:Dr Vibha Rai
Deposited On:31 Oct 2012 09:45
Last Modified:31 Oct 2012 09:45

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