Oncology and Metabolism, The University of Sheffield Faculty of Medicine, Dentistry and Health, Sheffield, UK
Gynaecology, St Michael's Hospital, Bristol, UK.
BMJ Open. 2023 Jul 26;13(7):e069146. doi: 10.1136/bmjopen-2022-069146.
In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. However, there is limited qualitative research regarding their use. The aims of the VALUE Study were to understand the decision-making process surrounding using or recommending add-ons; report sources of information for add-ons; and explore concerns for safety and effectiveness when considering their use.
'VALUE' is a qualitative semistructured interview study using inductive thematic analysis of anonymised transcriptions.
Participants were recruited from a broad geographical spread across the UK and Australia from public and private clinical settings.
Patients (n=25) and health professionals (embryologists (n=25) and clinicians (n=24)) were interviewed. A purposive sampling strategy was undertaken. The sampling framework included people having state-subsidised and private cycles, professionals working in public and private sectors, geographical location and professionals of all grades.
Patients often made decisions about add-ons based on hope, minimising considerations of safety, efficacy or cost, whereas professionals sought the best outcomes for their patients and wanted to avoid them wasting their money. The driving forces behind add-on use differed: for patients, a professional opinion was the most influential reason, whereas for professionals, it was seen as patient driven. For both groups, applying the available evidence to individual circumstances was very challenging, especially in the sphere of IVF medicine, where the stakes are high.
There is scope to build on the quality of the discourse between patients and professionals. Patients describe valuing their autonomy with add-ons, but for professionals, undertaking informed consent will be critical, no matter where they sit on the spectrum regarding add-ons.
osf.io/vnyb9.
体外受精（IVF）附加治疗是在进行 IVF 周期的同时提供的附加程序，旨在提高活产率。它们存在争议，因为缺乏支持其疗效和安全性的证据，并且通常会给患者带来额外的经济负担。尽管如此，它们还是很受欢迎。然而，关于它们的使用，定性研究的数量有限。VALUE 研究的目的是了解使用或推荐附加治疗的决策过程；报告附加治疗的信息来源；并探讨在考虑使用附加治疗时对安全性和有效性的关注。
“VALUE”是一项定性半结构式访谈研究，对匿名转录本进行归纳主题分析。
参与者是从英国和澳大利亚广泛的地理区域内的公共和私人临床环境中招募的。
对 25 名患者和卫生专业人员（胚胎学家（25 名）和临床医生（24 名））进行了访谈。采用了有目的的抽样策略。抽样框架包括接受国家补贴和私人周期的人、在公共和私营部门工作的专业人员、地理位置和各级专业人员。
患者通常根据希望做出关于附加治疗的决定，而很少考虑安全性、疗效或成本，而专业人员则为患者寻求最佳结果，并希望避免他们浪费金钱。使用附加治疗的驱动力不同：对于患者，专业意见是最有影响力的原因，而对于专业人员，这被视为患者驱动的。对于这两个群体，将现有证据应用于个人情况都非常具有挑战性，尤其是在 IVF 医学领域，风险很高。
有必要提高患者和专业人员之间的对话质量。患者描述了对附加治疗的自主权的重视，但对于专业人员来说，无论他们对附加治疗的立场如何，进行知情同意将是至关重要的。
osf.io/vnyb9。
