When applied systematically, patient-centred care offers significant benefits to patients, staff and the clinic.
Benefits for patients
There is strong evidence that patient-centred care has direct benefits on patients’ wellbeing and that continuity of care reduces treatment concerns and improves treatment tolerability (13). While a live birth is the goal of ART, the reality is that most cycles fail.
Multiple attempts are often needed to improve the chance of success. However, ART is stressful and the psychological burden of treatment is one of the most commonly cited reasons for stopping treatment (14).
Taken overall, evidence shows that a patient-centred approach in fertility care settings can:
- increase patient satisfaction and emotional wellbeing
- enhance patient self-care
- improve patient understanding of and compliance with treatment protocols; and
- increase the likelihood of patients continuing
- treatment until a viable pregnancy is achieved, which in turn leads to higher cumulative live birth rates.
Benefits for staff
Decreasing the stress of treatment not only has a positive impact on patients but is also likely to improve staff wellbeing, job satisfaction, engagement and retention. To achieve these benefits for patients and staff, clinics need to develop a patient- centeredness implementation plan with the following key elements:
- The increasing complexity of ART requires a highly specialised workforce. Patients expect fertility staff to be knowledgeable, trustworthy, empathetic and supportive. They value good relationships with fertility clinic staff who display the appropriate attitude(15). All fertility clinic staff require comprehensive training in all aspects of ART including the medical and psychological aspects as well as communication skills in order to meet patients’ needs. Staff also require ongoing training, education and support to fine tune the skills and resources they need to deliver high quality person-centred care.
- Staff-patient ratios need to allow staff sufficient time to meet the information and support needs of individual patients.
- The physical environment should be comfortable and allow privacy for staff-patient interaction.
- The IT system must give staff immediate access to up-to-date information about the progress of individual patient’s treatment so that they can respond to any treatment-related questions.
- Regular patient experience questionnaires, robust patient feedback and a clear complaints process allow staff to continuously review and improve their care.
Benefits for the clinic
In today’s competitive environment, there are clear benefits for clinics that implement patient-centred care. Drop-out rates decrease if patients are well supported and assisted in managing the emotional challenges of ART. This, in turn, means that they undergo more treatment cycles, which improves their chances of having a baby and the clinic’s bottom- line and cumulative success rate. Patients who have a positive care experience will recommend the clinic to others. Conversely, patients who have a negative care experience will advise others to avoid the clinic in question. The power of social media to endorse or criticise clinics should not be underestimated.
The value of a patient-friendly physical environment
A welcoming and comfortable physical environment enhances patients’ overall experience of care. The clinic environment should be appropriate for everyone who attends. While fertility clinics are all about helping people to have babies, a significant number of outcomes are unsuccessful. Patients who have experienced many failed cycles may find it distressing to see pictures of babies on display in clinics. Non- heterosexual individuals and couples appreciate diverse patient groups being visually represented and included in images displayed in a clinic setting or on clinic websites.
Patients also highlight the importance of ensuring privacy. Patients report that it can be physically and emotionally uncomfortable to be asked to remove clothing only to then wait a long time for treatment to commence, particularly if there are inadequate measures in place to protect their privacy. Given the sensitivities involved in treatment, privacy should also be ensured in all conversations between patients and clinic staff, particularly when conveying bad news. Discussions about the outcome of egg collections should be handled sensitively and with regard to the privacy of patients, noting that it can be disturbing for patients to overhear details of the outcome of other women’s egg collections.
The same applies to conversations regarding the number or quality of embryos available for transfer. Patients report that privacy can also be an issue when they are called without warning at work or in other public places where they are not able to comfortably talk about their treatment or process news relating to adverse outcomes.
Comfortable, private spaces should be available for face-to-face staff-patient interactions. If staff communicate with patients by telephone, they need to ensure that the timing is convenient for the patient and that they have privacy during the conversation.