OPPORTUNITIES TO OPTIMIZE PATIENT EXPERIENCE IN THE IN VITRO FERTILIZATION (IVF) CLINIC AND THE ROLE OF GENETIC COUNSELORS

Renata Thoeny; Nour Chanouha; Karen M. Summers; Alithea Zorn; Hakan Duran; Kendra L. Schaa

doi:10.1016/j.fertnstert.2024.07.510

OBJECTIVE We aimed to understand factors influencing patient satisfaction with genetics education and psychosocial support in an IVF clinic without a genetic counselor (GC), and how the role of a GC may fill gaps in care. MATERIALS AND METHODS This is a mixed-method study at an academic medical center. Participants were contacted from a registry of patients who had previously been seen at the IVF clinic. A total of 133 previous first-time IVF patients completed a survey assessing satisfaction with genetics education and psychosocial support, as well as decisional conflict about genetic testing. Kruskal-Wallis tests were used to compare satisfaction level to demographic and clinical variables. Spearman’s correlation was used to analyze decisional conflict. From survey respondents, 12 individuals participated in focus groups which expanded on themes identified in the survey responses. Thematic analysis was performed using interpretive description. RESULTS Participants reported overall high satisfaction with the genetics education they received in the clinic, with 78.9% being somewhat or extremely satisfied with this education. Participants who were satisfied with their genetics education were statistically more likely to be satisfied with the information received about genetic testing results (H = 21.3, p < 0.01) and to be confident using those results in future care decisions (H = 9.9, p < 0.01). Focus groups revealed patient misconceptions about genetic testing options. Participants confirmed a desire for thorough pre-test counseling about testing options tailored to their personal values and goals and post-test counseling centered around continuity of care. Our data showed that the decision to pursue genetic testing is influenced by multiple factors and focus group patients expressed trust in their providers to offer them directive guidance relative to their genetic testing options. Overall, there was low decision conflict about genetic testing (mean of 22.3, range: 0-100) and satisfaction with genetics education was inversely correlated with decisional conflict (rs = -0.42, p < 0.05). When asked about preferred method of genetic testing education, in-person visit with a GC scored highest, with a mean score of 84.1 and a median of 96, which was not the standard of education in this clinic. CONCLUSIONS Patients felt generally satisfied with the genetics education and psychosocial support provided by the clinical providers in an academic IVF center. Gaps in care included a desire for more thorough counseling about genetic testing options both pre- and post-test, more directive guidance from providers, and increased psychosocial support through external sources such as support groups. Participants were in favor of many presented methods of education, but an in-person meeting with a GC for genetic testing education was the preferred choice of patients. IMPACT STATEMENT Our study contributes to understanding drivers of satisfaction with genetics education and psychosocial support for IVF patients and serves as an incitement to IVF clinics to leverage the skills of GCs to address current gaps in care.

OPPORTUNITIES TO OPTIMIZE PATIENT EXPERIENCE IN THE IN VITRO FERTILIZATION (IVF) CLINIC AND THE ROLE OF GENETIC COUNSELORS

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