title: Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care.
abstract: OBJECTIVE
  Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up?
  
  
  CONCLUSIONS
  Tailored expectant management of at least 6 months in couples with unexplained infertility is not associated with the experiences with quality of care or trust in their physician.
  
  
  BACKGROUND
  In couples with unexplained infertility and a good prognosis of natural conception within 1 year, expectant management for 6-12 months does not compromise ongoing birth rates and is equally as effective as starting medically assisted reproduction immediately. Therefore, TEM is recommended by various international clinical guidelines. Implementation of TEM is still not optimal because of existing barriers on both patient and professional level. An important barrier is the hesitance of professionals to counsel their patients for TEM because they fear that patients will be dissatisfied with care. However, if and how adherence to TEM actually affects the couples' experience with care is unknown. Experiences with the quality care can be measured by evaluating the patient-centredness of care and the patients' trust in their physician.
  
  
  METHODS
  This is a retrospective cross-sectional study. A survey with written questionnaires was performed among all couples who participated in the retrospective audit of guideline adherence on TEM in 25 Dutch clinics.
  
  
  METHODS
  Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis (>30%) of natural conception within 1 year based on the Hunault prediction model. We used patient's questionnaires to collect data on the couples' experience with the quality of care and possible confounders for their experiences other than having undergone TEM or not. Multilevel regression analyses were performed to investigate case-mix adjusted association of TEM with the patient-centredness of care (PCQ-Infertility) and the patients' trust in their physician (Wake Forest Trust Scale).
  
  
  RESULTS
  Couples who adhered to TEM experienced the quality of care on the same level as couples who were exposed to early treatment, i.e. started fertility treatment within 6 months after fertility work-up. There were no associations between adherence to TEM and the patient-centredness of care or the patients' trust in their physician.
  
  
  CONCLUSIONS
  Because this study is retrospective, recall bias might occur. Furthermore, we were unable to measure the difference in experience with care over time. Therefore, our results have to be interpreted carefully.
  
  
  CONCLUSIONS
  Prospective research on couples undergoing TEM have to be performed to provide more detailed insight in the patients' experiences with the decision making process and subsequently the expectant period. Tackling the barriers surrounding TEM, i.e. better counselling and more patient information material, could further improve patient experiences with the quality of care for couples who are advised TEM.
  
  
  BACKGROUND
  Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none.
  
  
  BACKGROUND
  www.trialregister.nl NTR3405.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: F A M
authors.initials: FA
authors.lastname: Kersten
authors.affiliation: Scientific institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: R P G M
authors.initials: RP
authors.lastname: Hermens
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: D D M
authors.initials: DD
authors.lastname: Braat
authors.affiliation: Department of Obstetrics and Gynaecology, Slingeland Ziekenhuis, PO Box 169, 7000 AD, Doetinchem, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Tepe
authors.affiliation: Department of Obstetrics and Gynaecology, Wilhelmina Ziekenhuis Assen, PO Box 30001, 9400 RA, Assen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Sluijmer
authors.affiliation: Department of Obstetrics and Gynaecology, Isala Clinics, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
authors.forename: W K
authors.initials: WK
authors.lastname: Kuchenbecker
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, PO Box 22660, Amsterdam DD 1100, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Van den Boogaard
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5005 SA Adelaide, Australia.
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Goddijn
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands willianne.nelen@radboudumc.nl.
authors.forename: W L D M
authors.initials: WL
authors.lastname: Nelen
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008297:Male; D009426:Netherlands; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards; D011379:Prognosis; D011787:Quality of Health Care / Q000592:standards*; D013997:Time Factors
keywords: early treatment; expectant management; experience with care; guideline adherence; patient-centredness; prognostic model; trust in physician; unexplained infertility