Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/86314
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Type: Journal article
Title: Patients' and professionals' barriers and facilitators of tailored expectant management in subfertile couples with a good prognosis of a natural conception
Author: van den Boogaard, N.
van den Boogaard, E.
Bokslag, A.
van Zwieten, M.
Hompes, P.
Bhattacharya, S.
Nelen, W.
van der Veen, F.
Mol, B.
Citation: Human Reproduction, 2011; 26(8):2122-2128
Publisher: Oxford University Press
Issue Date: 2011
ISSN: 0268-1161
1460-2350
Statement of
Responsibility: 
N.M. van den Boogaard, E. van den Boogaard, A. Bokslag, M.C.B. van Zwieten, P.G.A. Hompes, S. Bhattacharya, W. Nelen, F. van der Veen, and B.W.J. Mol
Abstract: BACKGROUND European guidelines on fertility care emphasize that subfertile couples should receive information about their chances of a natural conception and should not be exposed to unnecessary treatments and risks. Prognostic models can help to estimate their chances and select couples with a good prognosis for tailored expectant management (TEM). Nevertheless, TEM is not always practiced. The aim of this study was to identify any barriers or facilitators for TEM among professionals and subfertile couples. METHODS A qualitative study was performed with semi-structured in-depth interviews of 21 subfertile patients who were counselled for TEM and three focus-group interviews of 21 professionals in the field of reproductive medicine. Two theoretical models were used to guide the interviews and the analyses. The primary outcome was the set of identified barriers and facilitators which influence implementation of TEM. RESULTS Among the subfertile couples, main barriers were a lack of confidence in natural conception, a perception that expectant management is a waste of time, inappropriate expectations prior to the first consultation, misunderstanding the reason for expectant management and overestimation of the success rates of treatment. Both couples and professionals saw the lack of patient information materials as a barrier. Among professionals, limited knowledge about prognostic models leading to a decision in favour of treatment was recognized as a main barrier. A main facilitator mentioned by the professionals was better management of patients’ expectations. CONCLUSIONS We identified several barriers and facilitators which can be addressed to improve the implementation of TEM. These should be taken into account when designing future implementation strategies.
Keywords: Infertility; prognostic models; implementation; barriers; expectant management
Description: First published online: June 10, 2011
Rights: © The Author 2011
RMID: 0020136866
DOI: 10.1093/humrep/der175
Appears in Collections:Obstetrics and Gynaecology publications

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