A novel intervention for medical waiting periods in IVF and early pregnancy

Abstract

Patients who make use of healthcare services have to deal with all kind of waiting periods like waiting for the results of a biopsy or waiting for the results of a fertility treatment. Waiting periods can cause high levels of distress because the outcomes of these waiting periods are often unpredictable, uncontrollable and difficult to cope with. Aim of this thesis was to investigate a Positive Reappraisal Coping Intervention (PRCI) for waiting periods within two different populations. The PRCI was investigated among women during an IVF/ICSI treatment and among pregnant women with a history of miscarriages. The PRCI is an intervention comprising of an explanatory leaflet and 10 statements, to be read at least once in the morning and once in the evening. Both quantitative and qualitative methods were used to investigate the PRCI. The first part of the thesis describes the quantitative studies that were focused on the waiting period in an IVF/ICSI treatment. The overall aim was to investigate the effect of the PRCI on psychological well-being of women waiting for the outcome of an IVF/ICSI treatment. Main findings are: women who used the PRCI and daily monitored their emotions during the waiting period of an IVF/ICSI treatment reported significantly more challenge appraisals and increased their use of the coping strategy positive reappraisal. Furthermore these women significantly had more positive emotions but not significantly less anxiety, depression or negative emotions. Women who used the PRCI intervention without daily monitoring of emotions had significantly lower anxiety levels during the waiting period and six weeks after the start of the waiting period. Use of the PRCI had no significant effect on treatment outcome when delivered in combination with daily monitoring of emotions but PRCI had a significant effect on clinical pregnancies when delivered without concurrent use of daily monitoring of emotions. The second part of the thesis describes the qualitative methods to assess the waiting periods of pregnant women with a history of miscarriage. The overall aim was to explore whether the PRCI could be an adjunct intervention for women with a history of miscarriage in a subsequent pregnancy. Main finding of these studies are: women with a history of miscarriage were able to use the PRCI in the first three weeks of their pregnancy. PRCI was never described as a negative experience. Women adapted the way in which they used the PRCI based on their judgment about the effect, the intensity of the emotions they experienced, or whether they felt the effort to use these instruments to be worthwhile or not. Another aim of the qualitative studies was to explore emotions and coping strategies of pregnant women with a history of miscarriages. Focus groups revealed two important core categories, “uncertainty” and “bracing”. Three interpretive themes described as “facing loss”, “dealing with waiting” and “handling mixed feelings” and one overarching theme described as “balancing between loss of control and searching for control” emerged out of the qualitative data of pregnant women with a history of miscarriage.