Gallagher Siun, Kerridge Ian, Newson Ainsley, Attinger Sara, Norman Robert J, Lipworth Wendy
The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, NSW, Australia.
The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, NSW, Australia; Royal North Shore Hospital, Haematology Department, Royal North Shore Hospital, St Leonards, NSW, Australia.
Reprod Biomed Online. 2024 Feb;48(2):103637. doi: 10.1016/j.rbmo.2023.103637. Epub 2023 Oct 22.
What factors do assisted reproductive terchnology (ART) providers take into account when they make decisions about offering 'add-ons'?
A qualitative analysis of interviews with 31 ART professionals, focusing on their views and experiences in relation to add-ons, including the factors that are considered when doctors make decisions about their use.
The participants reported that a range of considerations are taken into account when it comes to justifying the use of a particular add-on in a given circumstance, including the likelihood of benefit and harm, patients' perceived psychological needs and preferences, and organizational expectations. Importantly, patient preferences, psychological factors and low risk of harm appear to be stronger motivations than increasing the likelihood of a live birth or the desire to innovate.
These findings suggest that it cannot be taken for granted that add-ons and innovation are closely linked. One possible response to this would be regulatory reform; for example, only allowing 'unproven' add-ons to be used in the context of formal scientific evaluation. Alternatively, it could be made clear that add-ons that are not undergoing formal evaluation have more in common with other therapies lacking a clear evidence base, such as complementary and alternative medicines, than with conventional medical practice. Practices in relation to add-ons may also require a focus on the responsibilities of corporations, and the standards applying to purveyors of consumer goods and services.
辅助生殖技术（ART）提供者在决定提供“附加项目”时会考虑哪些因素？
对31名ART专业人员的访谈进行定性分析，重点关注他们对附加项目的看法和经验，包括医生在决定使用附加项目时所考虑的因素。
参与者报告称，在特定情况下证明使用特定附加项目合理时，会考虑一系列因素，包括受益和伤害的可能性、患者感知的心理需求和偏好以及组织期望。重要的是，患者偏好、心理因素和低伤害风险似乎比提高活产可能性或创新欲望更具推动作用。
这些发现表明，不能想当然地认为附加项目与创新紧密相连。对此的一种可能回应是进行监管改革；例如，只允许在正式科学评估的背景下使用“未经证实的”附加项目。或者，可以明确指出，未进行正式评估的附加项目与其他缺乏明确证据基础的疗法（如补充和替代医学）有更多共同之处，而与传统医疗实践不同。与附加项目相关的做法可能还需要关注企业的责任以及适用于消费品和服务供应商的标准。
