title: Patient centred care in infertility health care: direct and indirect associations with wellbeing during treatment.
abstract: OBJECTIVE
  To investigate whether different dimensions of patient centred care (PCC) were directly associated with wellbeing or indirectly, via lower concerns about medical procedures and/or increased tolerability of treatment.
  
  
  METHODS
  Cross-sectional study with 322 women and 111 men undergoing fertility diagnosis or treatment recruited online and in clinical setting. Participants completed questionnaires that assess PCC (PCQ-Infertility), individual (BSI Anxiety and Depression subscales) and relational wellbeing (FertiQoL Relational Domain), treatment concerns (CART Procedural Concerns scale) and tolerability (FertiQoL Tolerability Domain) and they filled a socio-demographic and fertility data file.
  
  
  RESULTS
  All dimensions of PCC were positively associated with better wellbeing except for organization of care. Information provision and continuity of care were indirectly associated with better individual wellbeing, the first via lower treatment concerns and the second via higher treatment tolerability. Competence, accessibility, continuity and communication were indirectly associated with better relational wellbeing via higher treatment tolerability.
  
  
  CONCLUSIONS
  Patient centred care promotes wellbeing during treatment. PCC is directly associated to wellbeing but also indirectly. The mode of action of the different PCC dimensions on wellbeing varies.
  
  
  CONCLUSIONS
  To promote patients' wellbeing during treatment clinics should provide treatment related information and allow patients to establish a stable clinical relationship with a trustworthy and competent physician.
authors.affiliation: School of Psychology, Cardiff University, Cardiff, UK; Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal. Electronic address: GameiroS@cardiff.ac.uk.
authors.forename: Sofia
authors.initials: S
authors.lastname: Gameiro
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Canavarro
authors.forename: Jacky
authors.initials: J
authors.lastname: Boivin
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D003142:Communication; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D007246:Infertility / Q000523:psychology* / Q000628:therapy*; D008297:Male; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D010549:Personal Satisfaction; D010817:Physician-Patient Relations; D057285:Precision Medicine / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D027724:Reproductive Techniques, Assisted / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Anxiety; Depression; FertiQoL; Infertility; Patient centered care; Quality of life