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Nordic couples' decision-making processes during assisted reproduction treatments.
Nordic Council of Ministers, Nordic School of Public Health NHV.
Fertility Center Scandinavia , Gothenburg , Sweden.
Nordic Council of Ministers, Nordic School of Public Health NHV.
2013 (English)In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 4, no 2, 49-55 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study couples' perceptions of their decision-making process during the first three years of infertility treatments.

STUDY DESIGN: This study is a part of a larger project studying the decision-making processes of 22 infertile heterosexual couples, recruited from fertility clinics in all five Nordic countries, over a three year period. A descriptive qualitative method was used.

MAIN OUTCOME MEASURES: Process of decision-making during assisted reproduction treatments.

RESULTS: Seventeen couples had succeeded in becoming parents after approximately three years. Our study suggests that the decision-making process during fertility treatments has three phases: (i) recognizing the decisions to be made, with subcategories; the driving force, mutual project, (ii) gathering knowledge and experience about the options, with subcategories; trust, patient competence, personalized support, and (iii) adapting decisions to possible options, with subcategories; strategic planning, adaption. The core category was "maintaining control in a situation of uncertainty."

CONCLUSIONS: Two parallel processes affect couples' decision-making process, one within themselves and their relationship, and the other in their contact with the fertility clinic. Couples struggle to make decisions, trusting clinic personnel for guidance, knowledge, and understanding. Nevertheless, couples expressed disappointment with the clinics' reactions to their requests for shared decision-making.

Place, publisher, year, edition, pages
2013. Vol. 4, no 2, 49-55 p.
Keyword [en]
Infertility; ART treatment; Decision-making; Nordic countries
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3735DOI: 10.1016/j.srhc.2013.04.003PubMedID: 23663922OAI: oai:DiVA.org:norden-3735DiVA: diva2:786505
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved
In thesis
1. Nordic and Infertile: A study of options and decisions
Open this publication in new window or tab >>Nordic and Infertile: A study of options and decisions
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The aim of this thesis was to obtain an overview over the options of Nordic infertile couples regarding assisted reproduction treatment, and to follow couples’ arguments and decision-making process to make relevant decisions about these options.

Methods: Quantitative and qualitative methods were used. The study design was inspired by Ecological systems theory, where data was gathered from laws and regulations (macro-level), fertility clinics (meso-level) and the couples using these options (micro-level). Study I consists of results from a review of the legislations in the five Nordic countries and results from a questionnaire that was sent to all fertility clinics to gather information about available options. Papers II and III present the findings of the interviews with 22 Nordic couples, after their first appointment with a specialist at the fertility clinic. The couples came from Denmark (3), Finland (6), Iceland (3), Norway (4) and Sweden (6). Study IV presents the findings of follow-up interviews with the same couples approximately three years later. For the qualitative study the tools of Grounded Theory were used.

Findings: In Study I it was found that Nordic couples generally have good access to assisted reproductive technology treatments (ART), although it is not evenly distributed and there are restrictions related to certain criteria, such as age. There are national differences in the legislations, especially regarding gamete donation. These differences open up for cross-border reproductive care, andmore than one third of the fertility clinics offered treatment to people from other countries. Study II describes the decision-making process of the couples when determining the “right time” to try for a child. The couples mention the need to feel prepared for parenthood; such as a stable social situation, and once they felt prepared they became more susceptible to decision-making catalysts, such as influence from friends and family. Fear of infertility made the couple accelerate their decision regardless of preparation. In Study III the decision-making process of seeking medical help is illustrated. The core category was “negotiation and re-negotiation”. The process of decision-making is first to accept that they have a problem in common, secondly that they need knowledge and finally to take action and get help. Study IV deals with the decision-making process during treatments. Of 22 couples, 17 had succeeded at becoming parents after approximately three years, three couples were still trying and two had not decided how to continue. The core category was “maintaining control in an uncertain situation”. The couples tried to keep focus on the goal and to learn to deal with the new world with various methods.

Conclusions:The structure of and the access to service for infertile couples differ between the Nordic countries. Some of the differences, e.g. regarding subsidy systems and waiting time, affected the decision making process since they could mean a delay in the treatment process or whether a private or public clinic was chosen. Additionally, a couple consists of two individuals with independent decision-making processes, which makes joint decision-making difficult and time-consuming. The couples have to negotiate their way to a consensus and are constantly confronted with new choices they need to re-negotiate on. The decision-making process, when dealing with infertility, is not a straight line, but rather a chain of small decisions affected by feelings, context and situation

Abstract [is]

Markmið: Markmið rannsóknarinnarvar að ná yfirsýn yfir þeim tæknifrjóvgunarmöguleikum sem norrænum pörum sem kljást við ófrjósemi stendur til boða, og að fylgja rökleiðslu þeirra og ákvarðanatökuferli sem tengist þessum möguleikum.

Aðferð: Megindlegum og eigindlegum aðferðum var beitt.Hönnun rannsóknarinnarsótti innblástur til Ecological systems theory, með söfnun gagna frálögum og reglugerðum (macro-stig), tæknifrjóvgunarstofum (meso-stig) og frá pörunum sem nýttu sérþessa möguleika (micro-stig). Grein Iinniheldur niðurstöður rýni á reglugerðum Norðurlandanna fimm, ásamt niðurstöðum spurningalista sem sendur var öllum tæknifrjóvgunarstofum til að fá upplýsingar um þá möguleika sem stóðu til boða. GreinarII og III kynna niðurstöður úr viðtölum við 22 norræn pör sem fórufram eftir fyrsta tíma þeirra hjá sérfræðingi á tæknifrjóvgunarstofu. Pörin komu frá Danmörku (3), Finnlandi (6), Íslandi (3), Noregi (4) og Svíþjóð (6). Grein IV kynnir niðurstöður framhaldsviðtala við sömu pör sem fóru fram u.þ.b. þremur árum síðar. Fyrir eigindlega hluta rannsóknarinnar var aðferðum úr Grounded theory beitt.

Niðurstöður: Grein Isýndi fram á að aðgengi norrænna para að tæknifrjóvgunarmeðferðum er alla jafna gott. Þó er aðgengið er ekki jafndreift og það eru hömlur sem tengjast tilteknum skilyrðum, svo sem aldri. Það er munur á reglugerðum landanna, sérstaklega hvað snýr að kynfrumugjöf. Þessi mismunur opnar fyrir tæknifrjóvgunarþjónustu yfir landamæri, en meira en þriðjungur tæknifrjóvgunarstofa buðu þjónustu sína fólki frá öðrum löndum. Grein II lýsir ákvarðanatökuferli paranna þegar þau ákvarða hvenær sé „réttur tími“ til að reyna að eignast barn. Pörin nefndu þörfina fyrir að finnast þau vera undirbúin fyrir foreldrahlutverkið, svo sem að hafa trygga félagslega stöðu, en að því búnu urðu þau móttækilegri fyrir ákvarðanatökuhvötum, svo sem áhrifum frá vinum og fjölskyldu. Óttivið ófrjósemi olli því að pörin flýttu ákvörðun sinni, óháð öðrum þáttum. Grein III varpar ljósi á ákvarðanatökuferlið sem leiðir til þess að leitað er aðstoðar sérfræðinga. Kjarnaflokkurinn (e. core category) var „að semja og endursemja“. Ferli ákvarðanatökunnar hefst með því að parið þarf að sætta sig viðað þau eigi við sameiginlegt vandamál að stríða, því næst þurfa þau að afla sér vitneskju, og loks að bregðast við ogleita hjálpar. Grein IV fjallar um ákvarðanatökuferlið meðan á meðferð stendur. Af 22 pörum, þá hafði 17 tekist að verða foreldrar eftir þrjú ár, þrjú pör voru enn að reyna og tvö pör höfðu ekki tekið ákvörðun um framhaldið. Kjarnaflokkurinn var „ að halda stjórn í ótryggum aðstæðum“. Pörin reyndu að einblína á markmiðið og að nota ýmsar aðferðir til þess að höndla nýjar aðstæður.

Samantekt: Það er munur á uppbyggingu og aðgengi að þjónustu fyrir ófrjó pör milli Norðurlandanna. Sumir þessara mismunandi þátta, t.d. niðurgreiðslur og biðtími, höfðu áhrif á ákvarðanatökuferlið þar sem þeir gátu tafið meðferðina eða ráðið því hvort parið leitaði til einkastofu eða opinberrar stofnunar. Par samanstendur af tveimur einstaklingumhvor um sig með eigiðákvarðanatökuferli, en það gerir sameiginlega ákvarðanatöku erfiða og tímafreka. Parið verður að semja til að komast að sameiginlegri niðurstöðu, en þarf síðan í sífellu að endursemja um nýja möguleika sem koma fram. Ákvarðanatökuferlið eins og það snýr að ófrjósemi er ekki bein lína,heldur er það keðja af litlum ákvörðunum sem mótast af tilfinningum, samhengi og aðstæðum.

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden, 2012. 70 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:1
Keyword
Nordic countries, in fertility, decision - making process, access, qualitative, ART
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3736 (URN)978-91-86739-29-4 (ISBN)
Public defence
2012-04-13, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-02-09 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved

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