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Rai, Vibha (2012) Development and evaluation of educational intervention to promote informed decision making regarding embryo transfer in IVF patients. PhD thesis, University of Nottingham.

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Abstract

Increasing the uptake of elective single embryo transfer is necessary to achieve the 10% HFEA limit for multiple IVF births in 2011. This thesis aims to explore patients’ and clinicians’ attitudes to eSET and to promote effective decision making regarding embryo transfer.

Study 1 compared neurobehavioural outcomes between twins and singletons in a prospective study of infants born very preterm (n=233). Despite having older (p=0.025) and higher social class (p=0.023) mothers, twins had the same risk of cognitive impairment at 2 years as singletons.

In study 2, a 44 item Attitudes to Twin Pregnancy scale (ATIPS) was developed and administered to a sample of clinicians, medical students and conference delegates (n=411). Item analysis reduced ATIPS to 2 short subscales. A-Twin (12 items) assessed perceptions of risks and benefits associated with a twin birth (α=0.7). A-SET (8 items) assessed attitudes to eSET (α=0.53).

Study 3 explored the reliability and validity of ATIPS-R in IVF patients. Exclusion of 2 A-SET items increased alpha to 0.8. Female patients (n=100) had more positive attitudes to a twin birth than clinicians (p=<0.001). Less than a third of patients felt that a twin birth was risky for infants and over 80% of doctors agreed that a twin birth was worth any risks to infants. First cycle IVF patients were more positive about eSET (p=<0.001) than women undergoing repeat cycles.

Study-4 developed a decision aid and evaluated its impact in a pilot randomised controlled trial (n=8). Lower decisional conflict in patients at embryo transfer was associated with more positive attitudes to twins at baseline (p=0.024) and less positive attitudes to eSET, (p=0.04). Although the attitudes of patients receiving the DA did not change, partners became more positive towards eSET (p=0.024).

Conclusion: Patients and clinicians underestimate the risk of a twin birth for infants and would benefit from educational interventions to promote eSET. The ATIPS-R is a useful measure for assessing the effectiveness of such interventions.

Abbreviations: SET- single embryo transfer; HFEA- Human fertility and embryology authority; IVF- In vitro fertilisation; A-Twin- attitude to risks and benefits of twins; ATIP- attitude to twin IVF pregnancy; A-SET attitude to single embryo transfer; eSET- elective single embryo transfer; DET- double embryo transfer; RCT – randomised control trial; DA- decision aid

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Glazebrook, C.
Subjects:	W Medicine and related subjects (NLM Classification) > WQ Obstetrics
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Community Health Sciences
Item ID:	12683
Depositing User:	EP, Services
Date Deposited:	31 Oct 2012 09:45
Last Modified:	16 Dec 2017 23:11
URI:	https://eprints.nottingham.ac.uk/id/eprint/12683

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