title: The PRCI study: design of a randomized clinical trial to evaluate a coping intervention for medical waiting periods used by women undergoing a fertility treatment.
abstract: BACKGROUND
  Many medical situations necessitate a stressful period of waiting for potentially threatening test results. The medical waiting period is often associated with negative anticipatory anxiety and rumination about the outcome of treatment. Few evidence-based self-help coping interventions are available to assist individuals manage these periods. Theory and research suggest that positive reappraisal coping strategies may be particularly useful for this type of unpredictable and uncontrollable stressful context. The objective of this study is to investigate the effects of a Positive Reappraisal Coping Intervention (PRCI) on psychological well-being of women waiting for the outcome of their fertility treatment cycle.
  
  
  METHODS
  In a three-armed randomized controlled trial, the effectiveness of the PRCI will be tested. Consecutive patients undergoing in vitro fertilisation in a Dutch university hospital and meeting selection criteria will be invited to participate. Those who agree will be randomized to one of three experimental groups (N=372). The PRCI Intervention group will receive the intervention that comprises an explanatory leaflet and the 10 statements designed to promote positive reappraisal coping, to be read at least once in the morning, once in the evening. To capture the general impact of PRCI on psychological wellbeing patients will complete questionnaires before the waiting period (pre-intervention), on day ten of the 14-day waiting period (intervention) and six weeks after the start of the waiting period (post-intervention). To capture the specific effects of the PRCI during the waiting period, patients will also be asked to monitor daily their emotions and reactions during the 14-day waiting period. The primary outcome is general anxiety, measured by the Hospital Anxiety and Depression Scale. Secondary outcomes are positive and negative emotions during the waiting period, depression, quality of life, coping and treatment outcome. During recruitment for the RCT it was decided to add a fourth non-randomized group, a PRCI Control group that received the PRCI and completed the questionnaires but did not complete daily monitoring.
  
  
  CONCLUSIONS
  Positive reappraisal is one of the few ways of coping that has been shown to be associated with increased wellbeing during unpredictable and uncontrollable situations like medical waiting periods. A simple evidence based self-help intervention could facilitate coping during this common medical situation. This RCT study will evaluate the value of a self-help coping intervention designed for medical waiting periods in women undergoing fertility treatment.
  
  
  BACKGROUND
  The study is registered at the Clinical Tials.gov (NCT01701011).
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands. h.d.l.ockhuysen@umcutrecht.nl.
authors.forename: Henrietta D L
authors.initials: HD
authors.lastname: Ockhuijsen
authors.forename: Agnes
authors.initials: A
authors.lastname: van den Hoogen
authors.forename: Nickolas S
authors.initials: NS
authors.lastname: Macklon
authors.forename: Jacky
authors.initials: J
authors.lastname: Boivin
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D006801:Humans; D007247:Infertility, Female / Q000523:psychology* / Q000628:therapy; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome