Page 138 - Shared Guideline Development Experiences in Fertility Care

Chapter 6
or two patients in previously described methods [18, 22, 23]. Another discussion point is the attrition of the members of both panels over the course of the study, which is considerably high, especially of the professional panel members in the third step of our study. A plausible explanation for this might be found in the fact that indicator development (rating and ranking 120 indicators) is time-consuming and within a second round, professionals may feel less urge in adding important points to the nal set of indicators.
Finally, some considerations for the use of these indicators in daily practice have to be addressed. First, the developed indicators in this study were based on a national multidisciplinary guideline on infertility, in which patient-centredness represented the primary goal in the development phase. is resulted in a high number of recommendations (n=120) for patient-centredness. Although patient- centredness is becoming increasingly important in the eld of infertility care, it could be questioned if this approach can be performed similarly in all existing guidelines, since patient involvement in guideline development is still not common practice and the number of recommendations regarding patient-centredness might be rather small [17]. Furthermore, we are aware of the fact that some of the selected indicators, mainly regarding the access to care, may be speci c for the Dutch setting (e.g. the unique role of the Dutch GP) and that this might have in uenced the choice of indicators. However, this guideline was also based on international evidence, which implies that most of the developed indicators are more or less applicable in other care models as well, occasionally by a broader interpretation of the indicators (e.g. by replacing the GP with other engaged healthcare professionals). Moreover, evidence suggests that European patients have a similar generic view on patient-centredness of fertility care [27]. Additionally, with regard to the use of indicators for patient-centredness to monitor the quality of patient-centred fertility care, we think that professionals do not need to set up a quality assurance system for patient-centredness separately, since most of the performance measures can be collected by simply asking the patient directly or by introducing a periodic questionnaire to be completed. A good example of such a questionnaire may be found in the ENDOCARE-questionnaire [27].
Conclusion and implications
is study describes the systematic, stepwise development of patients’ and professionals’ guideline-based quality indicators for patient-centredness in fertility care and provides an insight into the di erences in selection of quality indicators
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