Cardiff Fertility Studies Group, School of Psychology, Cardiff University, Cardiff, UK.
School of Medicine, Cardiff University, Cardiff, UK.
Hum Reprod. 2023 Feb 1;38(2):247-255. doi: 10.1093/humrep/deac262.
What are fertility staff experiences of managing COVID-19-related uncertainty after fertility clinics re-opened?
Staff identified many COVID-19-related uncertainty sources, the main being the COVID-19 health threat, to which most clinics and staff responded effectively by implementing safety protocols and building strong collaborative environments that facilitated the acquisition and application of information to guide organizational responses during a rapidly changing situation, but with costs for staff and patients.
COVID-19 created significant disruption in fertility care delivery, including temporary clinic closure and treatment delay. Patients experienced significant distress, including concerns regarding the impact of COVID-19 and its vaccine on fertility and pregnancy. Multiple studies show that COVID-19-related uncertainty is a major threat and burden for healthcare staff, but this has not been investigated in reproductive medicine.
STUDY DESIGN, SIZE, DURATION: A cross-sectional, online mixed-method bilingual (English, Spanish) survey (active 25 January-23 May 2021) was distributed to fertility staff across the UK, Latin America, and Africa.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Eligibility criteria were being a healthcare worker at a fertility clinic that had re-opened since its COVID-19-related closure, 18 years of age or older and ability to respond in English or Spanish. The survey was created in English, translated to Spanish, made available using Qualtrics, and consisted of four parts: (i) background and physical and mental wellbeing, (ii) open-ended questions regarding COVID-19 uncertainty, (iii) appraisal items regarding perceptions and impact of uncertainty, and (iv) changes in the workplace. The British Fertility Society and the African Network and Registry of Assisted Reproduction circulated the survey across the UK and Africa via email hyperlinks and social media platforms. The Argentinian Society of Reproductive Medicine and the Latin American Network of Assisted Reproduction distributed the survey across Latin America in the same manner. Thematic analysis was performed on responses from open-ended question to produce basic codes. Deductive coding grouped sub-themes across questions into themes related to the theory of uncertainty management. Descriptive statistics and repeated measures analysis of variance were used on the quantitative data.
In total, 382 staff consented to the survey, 107 did not complete (28% attrition), and 275 completed. Sixty-three percent were women, 69% were physicians, and 79% worked at private clinics. Thematic analysis produced 727 codes, organized in 92 sub-themes, and abstracted into 18 themes and one meta-theme reflecting that uncertainty is stressful but manageable. The types of uncertainties related to the threat of COVID-19 (20.6%), unpredictability of the future (19.5%), failure of communication (11.4%), and change in the workplace (8.4%). Staff appraisals of negative and positive impact of uncertainty were significantly lower (P < 0.001) than appraisals of stress, controllability, and having what it takes to cope with uncertainty. To process uncertainty, clinics focused on information dissemination (30.8%) and building a collaborative work environment (5.8%), while staff employed proactive coping (41.8%) and emotional and cognitive processing (9.6%). Main organizational responses consisted on work restructuring (41.3%, e.g. safety protocols), adapting to adversity (9.5%, e.g. supplies, preparation), and welfare support (13.8%), though staff perceived lack of support (17.5%). Negative consequences of uncertainty were worse self- and patient welfare (12.1%) and worse communication due to virtual medicine and use of mask (9.6%). Positive consequences were work improvements (8.3%), organizational adaptation (8.3%), improved relationships (5.6%), and individual adaptation (3.2%). Ninety-two percent of participants thought changes experienced in the workplace due to COVID-19 were negative, 9.1% nor negative nor positive, and 14.9% positive. Most staff thought that their physical (92.4%) and mental health (89.5%) were good to excellent.
LIMITATIONS, REASONS FOR CAUTION: Participants were self-selected, and most were physicians and embryologists working at private clinics based in Latin America. The study did not account for how variability in national and regional COVID-19 policy shaped staff experiences of uncertainty.
To address COVID-19 uncertainty, clinics need to promote collaborative (clinic, staff, patients) processing of uncertainty, clear team coordination and communication, organizational flexibility, and provision of support to staff and patients, with an emphasis on cognitive coping to decrease threat of and increase tolerance to uncertainty. Uncertainty management interventions bespoke to fertility care that integrate these components may increase clinics resilience to COVID-19-related and other types of uncertainty.
STUDY FUNDING/COMPETING INTERESTS: Cardiff University funded this research. S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon Richter, and grants from Merck Serono Ltd. F.Z.-H. reports speaker fees from Ferring Pharmaceuticals A/S and that he is a chair of the Latin American Registry of ART, Committee of Ethic and Public Policies, and Chilean Society of Obstetrics and Gynecology and a vice chair of the International Committee for monitoring ART. K.A., N.C., G.B., and J.B. report no conflict in relation to this work.
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生育科工作人员在生育科重新开放后，如何应对与 COVID-19 相关的不确定性？
工作人员确定了许多与 COVID-19 相关的不确定性来源，主要是 COVID-19 健康威胁，大多数诊所和工作人员通过实施安全协议和建立强大的协作环境来有效应对，这有助于在快速变化的情况下获取和应用信息，以指导组织应对，但这给员工和患者带来了成本。
COVID-19 对生育护理服务造成了重大干扰，包括诊所暂时关闭和治疗延迟。患者经历了严重的困扰，包括对 COVID-19 及其疫苗对生育和怀孕的影响的担忧。多项研究表明，与 COVID-19 相关的不确定性是医疗保健人员的主要威胁和负担，但生殖医学领域尚未对此进行调查。
研究设计、规模、持续时间：这是一项横断面、在线混合方法双语（英语、西班牙语）调查（2021 年 1 月 25 日至 5 月 23 日活跃），在英国、拉丁美洲和非洲向生育科的所有医护人员发放。
参与者/材料、设置、方法：合格标准是在 COVID-19 相关关闭后重新开放的生育科的医护人员，年龄在 18 岁或以上，并且能够用英语或西班牙语做出回应。该调查是用英语编写的，翻译成西班牙语，使用 Qualtrics 提供，由四部分组成：（i）背景和身心健康，（ii）关于 COVID-19 不确定性的开放性问题，（iii）关于感知和不确定性影响的评估项目，以及（iv）工作场所的变化。英国生育学会和非洲生殖医学网络和辅助生殖协会通过电子邮件链接和社交媒体平台在英国和非洲分发了该调查。阿根廷生殖医学学会和拉丁美洲辅助生殖网络以同样的方式在拉丁美洲分发了该调查。对来自开放性问题的回答进行了主题分析，以生成基本代码。演绎编码将子主题跨问题分组为与不确定性管理理论相关的主题。使用描述性统计和重复测量方差分析对定量数据进行分析。
共有 382 名员工同意参与调查，107 人未完成（28%的流失率），275 人完成了调查。63%是女性，69%是医生，79%在私人诊所工作。主题分析产生了 727 个代码，组织成 92 个子主题，抽象成 18 个主题和一个元主题，反映不确定性是有压力的，但可以管理。与 COVID-19 威胁相关的不确定性类型（20.6%）、未来的不可预测性（19.5%）、沟通失败（11.4%）和工作场所的变化（8.4%）。员工对不确定性的消极和积极影响的评估明显低于（P<0.001）对压力、可控性和应对不确定性所需的能力的评估。为了处理不确定性，诊所专注于信息传播（30.8%）和建立协作工作环境（5.8%），而员工则采用积极应对（41.8%）和情绪和认知处理（9.6%）。主要的组织反应包括工作重组（41.3%，例如安全协议）、适应逆境（9.5%，例如供应、准备）和福利支持（13.8%），尽管员工认为缺乏支持（17.5%）。不确定性的负面后果是自身和患者福利较差（12.1%）以及由于虚拟医学和使用口罩导致沟通不畅（9.6%）。积极的后果是工作改进（8.3%）、组织适应（8.3%）、关系改善（5.6%）和个人适应（3.2%）。92%的参与者认为由于 COVID-19 而导致工作场所发生的变化是负面的，9.1%既不是负面也不是正面，而 14.9%是正面的。大多数员工认为他们的身心健康状况良好至优秀（92.4%和 89.5%）。
局限性、谨慎的原因：参与者是自我选择的，大多数是在拉丁美洲的私人诊所工作的医生和胚胎学家。该研究没有考虑国家和地区 COVID-19 政策的差异如何影响员工对不确定性的体验。
为了应对 COVID-19 不确定性，诊所需要促进对不确定性的协作处理（诊所、员工、患者），明确团队协调和沟通，组织灵活性，并为员工和患者提供支持，重点是认知应对，以减少不确定性的威胁并增加对不确定性的容忍度。针对生育护理的不确定性管理干预措施，整合这些组件可能会提高诊所对 COVID-19 相关和其他类型不确定性的抵御能力。
研究资金/利益冲突：卡迪夫大学资助了这项研究。S.G. 报告了来自 Ferring Pharmaceuticals A/S 的咨询费、来自 Access Fertility、SONA-Pharm LLC、Meridiano Congress International 和 Gedeon Richter 的演讲费以及 Merck Serono Ltd 的资助。F.Z.-H. 报告了来自 Ferring Pharmaceuticals A/S 的演讲费，并担任拉丁美洲生殖医学登记处、伦理和公共政策委员会、智利妇产科协会和国际辅助生殖技术监测委员会的主席，以及拉丁美洲生殖医学登记处、伦理和公共政策委员会、智利妇产科协会和国际辅助生殖技术监测委员会的副主席。K.A.、N.C.、G.B. 和 J.B. 报告与这项工作没有利益冲突。
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