Page 136 - Shared Guideline Development Experiences in Fertility Care

Chapter 6
critically appraised evidence or consensus in a broad multidisciplinary group of professionals, which may hamper the likeliness of associated quality improvement initiatives to succeed. In addition, these studies only evaluated the patient- centredness of the clinical treatment phase within fertility care; other phases within patients’ clinical pathways, such as care by GPs, urologists and a er-care were omitted. Our study emphasises that the importance of including patients’ clinical pathways with regard to the high percentage of indicators on coordination and transition in professionals’ and access to care in patients’ nal set of indicators. Recently, studies have also reported on this close linkage between organisational determinants of care and other dimensions of patient-centredness as well as the need to apply a multidisciplinary approach in fertility care [4, 7, 27, 28].
By comparing the dimensions of patient-centredness between these non- guideline based instruments and our developed indicator sets, similarities but also noteworthy di erences can be identi ed. e importance of information provision and communication for measuring patient-centredness is also underlined by the results of non-guideline based instruments and even assigned to be top priority in quality improvement initiatives [4-6, 9, 29]. Even so, the accessibility, coordination and integration of fertility care appeared to be proportionally underexposed dimensions of patient-centredness [4-6, 9, 27].
e main strength of our study is the involvement of infertile patients and di erent professionals from various phases in fertility care. Furthermore, by separately developing the two sets of quality indicators, we were able to get insight into patients’ actual contribution and describe the di erences in the selected indicators as well as dimensions of patient-centredness between patients and professionals. However, by respecting di erent perspectives on patient-centred fertility care, one might argue against the development of two separate sets of quality indicators. Although mandatory to the aim of our study, three arguments for this approach need to be addressed. First, patients are the ultimate experts in patient-centredness of care, thus patients’ involvement is necessary [13]. Secondly, to create a high level of support and ownership for the developed indicators, professionals also need to play a major role in the development process from the start. Finally, this increases the chances to use the indicators for actually monitoring and improving the quality of patient-centred fertility care [18, 30, 31]. Nevertheless, due to the lack of agreement between patients’ and professionals’ selected indicators, our approach results in a relatively large aggregated indicator set (n=29), which could become an obstacle in the use for accreditation and quality monitoring goals. An option to
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