title: First contact: the intersection of demographics, knowledge, and appraisal of treatment at the initial infertility visit.
abstract: OBJECTIVE
  To determine the impact of the initial infertility visit on treatment-related knowledge, patient anxiety, and appraisals of treatment.
  
  
  METHODS
  Prospective survey.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Two hundred thirty-four English-speaking women aged 18-50 years attending their first infertility visit.
  
  
  METHODS
  Participants completed a survey assessing health literacy, knowledge, anxiety, and appraisals of the treatment process before and after their infertility visit.
  
  
  METHODS
  Knowledge of infertility and treatment and anxiety and appraisal scores.
  
  
  RESULTS
  Most participants were white and earned >$100,000/year and had at least a college education. Baseline knowledge of reproductive anatomy, assisted reproductive technology (ART), and fertility factors was modest but improved after the initial visit. Factors associated with higher knowledge included higher education and income, white or Asian ethnicity, and English as a primary language. Patient appraisals of treatment represented by the positive (Challenge) and negative (Threat and Loss) subscale scores on the Appraisal of Life Events (ALE) scale changed over time Negative appraisals of treatment and anxiety scores decreased and positive appraisals of treatment increased after the initial visit. Lower knowledge was associated with higher positive appraisal scores; lower health literacy was associated with higher anxiety and appraisal scores (positive and negative) after the visit. Black women had higher Challenge scores compared with white and Asian women. Hispanic women had higher anxiety scores than non-Hispanic women.
  
  
  CONCLUSIONS
  Infertility patients have modest baseline knowledge of fertility and infertility treatment. The initial infertility visit can improve this knowledge and decrease both negative appraisals of treatment and anxiety levels. Differences in knowledge and appraisal were seen across ethnic groups and other demographic variables. Physicians should individualize patient counseling to improve patients' knowledge and provide realistic treatment expectations while also reducing patient anxiety.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Krista J
authors.initials: KJ
authors.lastname: Childress
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Angela K
authors.initials: AK
authors.lastname: Lawson
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Marissa S
authors.initials: MS
authors.lastname: Ghant
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Gricelda
authors.initials: G
authors.lastname: Mendoza
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Eden R
authors.initials: ER
authors.lastname: Cardozo
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Edmond
authors.initials: E
authors.lastname: Confino
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: erica-marsh@northwestern.edu.
authors.forename: Erica E
authors.initials: EE
authors.lastname: Marsh
mesh_terms: D000328:Adult; D003625:Data Collection / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000628:therapy*; D009819:Office Visits / Q000639:trends; D010817:Physician-Patient Relations; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted / Q000639:trends; D016896:Treatment Outcome
keywords: Anxiety; appraisal; infertility; knowledge; treatment