Page 46 - Shared Guideline Development Experiences in Fertility Care

Chapter 3
Abstract
Background: Guideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centred network approach to develop ve harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in fertility care. We assessed the feasibility of this approach with a detailed process evaluation of the guideline development, professionals’ experiences, and time invested. Methods: e network structure comprised the centrally located patients and the steering committee; a multidisciplinary guideline development group (gynaecologists, physicians, urologists, clinical embryologists, clinical chemists, a medical psychologist, an occupational physician, and two patient representatives); and four monodisciplinary guideline development groups. e guideline development addressed patient-centred, organizational, and medical-technical key questions derived from interviews with patients and professionals. ese questions were elaborated and distributed among the groups. We evaluated the project performance, participants’ perceptions of the approach, and the time needed, including time for analysis of secondary sources, interviews with eight key gures, and a written questionnaire survey among 35 participants.
Results: Within 20 months, this approach helped us develop a multidisciplinary guideline for treating infertility and four related monodisciplinary guidelines for general infertility, unexplained infertility, male infertility, and semen analysis. e multidisciplinary guideline included recommendations for the main medical- technical matters and for organizational and patient-centred issues in clinical care pathways. e project was carried out as planned except for minor modi cations and three extra consensus meetings. e participants were enthusiastic about the approach, the respect for autonomy, the project coordinator’s role, and patient involvement. Suggestions for improvement included timely communication about guideline formats, the timeline, participants’ responsibilities, and employing a librarian and more support sta . e 35 participants spent 4497 hours in total on this project.
Conclusions: e novel patient-centred network approach is feasible for simultaneously and collaboratively developing a harmonized set of multidisciplinary and monodisciplinary guidelines around clinical care pathways for patients with fertility problems. Further research is needed to compare the e cacy of this approach with more traditional approaches.
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