Measuring Patient Experience

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Despite medical literature still claiming there is no definitive link between stress and infertility, it has concluded that it can interfere with hormone balance and ovulation, as well as libido in both sexes (see In my practice I see the massive effects that psychological stress (emotional discomfort) can have on a client, and the various ways it impedes desired outcomes such as achieving pregnancy and carrying to term. At least half of my treatment plans involve protocols to help alleviate stress and soothe emotions as a part of optimizing reproductive health. It should be clarified that 'stress' is a catch all term for emotional discomfort (psychological perspective), and that its impact on certain medical conditions is only really beginning to be understood.

Patient feelings are very difficult to randomize, control, or test against placebos (see post re: RCT – randomized controlled trials). It is simply a different model of research that needs to be used to better understand patient experience. Self reporting is a necessary component of this type of research and because of this, is often scrutinized for its validity. It is my humble opinion that large numbers of subjects in self-reported studies create validity, and that opinion is beginning to be shared by many others. That said, no matter what any research concludes, catering medical treatments to the needs of each individual is the pinnacle of quality care. This should always be remembered.

A local medical specialist recommended a textbook to me; JAMA Evidence (Journal of American Medical Association) – Users Guide to the Medical Literature – a manual for evidence based clinical practice – second edition. He believed it would deepen my understanding of western medical research and evidence based medicine. It is the same text he recommends to his medical residents. I wanted to share a passage from the book as it highlights the changing tides in modern medicine, the beginnings of a more patient centered model of healthcare, focusing on the importance of patient experience.

Why do we offer treatment to patients? There are 3 reasons. We believe that our interventions increase longevity, decrease symptoms, or prevent future morbidity. Decreasing symptoms or feeling better includes avoiding discomfort (pain, nausea, breathlessness, and so forth), distress (emotional suffering), and disability (loss of function).

At least in part because of the difficulty in measurement, for many years, clinicians were willing to substitute physiologic or laboratory tests for the direct measurement of these endpoints, or tended even to ignore them altogether. During the past 20 years, however, the growing prevalence of chronic diseases has led clinicians to recognize the importance of direct measurement of how people are feeling and the extent to which they are functioning in daily activities.

The IVF specialists I work with are in alignment with the passage above, and I am proud to work with such progressive physicians. I hear time and time again how they believe patient experience really matters, anything that can help with patients stress will improve their experience and aid in positive outcomes.

One more sign that the times when we hear the words 'stress has no impact on your fertility' are coming to an end is displayed on the American Society for Reproductive Medicine (ASRM) 'Stress and Infertility Fact Sheet', where it states; “Does stress cause Infertility? Probably not”. Therefore I must end this post the way all good medical literature ends, stating 'there is a need for more quality research to conclude, without a doubt that stress affects fertility'. In the meantime I am just going to maintain my assumption that it does, and wait for science to catch up!

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