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Immer wieder wird diskutiert, inwiefern Stress bzw. Stresserleben (akut oder chronisch) sich auf die Ergebnisse (Outcome) von Reproduktionsmedizin (artifizielle Reproduktionstechnologien, ART) auswirkt. Gibt es anhand bisheriger wissenschaftlicher Studien Beweise fur die Hypothese „Stress hat einen negativen Einfluss auf den Erfolg der ART“? Ein Review aktueller Literatur zum moglichen Zusammenhang zwischen Stress und ART-Outcome wurde erstellt. Die meisten aktuellen Studien, insbesondere Metaanalysen, zeigen keinen eindeutigen Zusammenhang zwischen Stress und ART-Outcome. Allerdings verursacht ART bei den Betroffenen Stress, der wiederum mit ein Grund fur die hohen Drop-out-Raten bei IVF (In-vitro-Fertilisation) und ICSI (intrazytoplasmatische Spermieninjektion) darstellt. Als medizinisch sinnvoll erachtete Therapien werden dadurch nicht selten vorzeitig beendet, und Paare konnen nicht von der kumulativen Schwangerschaftsrate profitieren. Eine Beratung der Patientinnen bzw. der Paare uber die o. g. Ergebnisse sind auserordentlich wichtig, um den Erfolgsdruck und den Stress der Therapie nicht noch zu erhohen. Psychosoziale Beratungs- und spezifische Therapieangebote sollten aktiv empfohlen und bereitgestellt werden, um Stress und Drop-out-Raten zu reduzieren.

Background Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory–practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. Methods We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Results Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational–emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory–practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Discussion Initiatives such as the International Patient Decision Aids Standards Collaboration influence standards for the design of decision support interventions. However, this analysis points to the need to undertake more work in providing theoretical foundations for these interventions.

Objective Our aim was to clarify and categorize information and decision support needs of pregnant women deciding about amniocentesis. Background Prenatal screening for Down’s syndrome (implemented in routine practice) generates a quantifiable risk of chromosome abnormality. To increase certainty, chromosomal material needs to be obtained through amniocentesis or other diagnostic test. Amniocentesis carries risks of pregnancy loss. Methods Semi-structured interviews were conducted with health professionals and pregnant women who had considered amniocentesis. The data were qualitatively analysed using a two-step thematic content analysis. Results A sample of 17 health professionals and 17 pregnant women were interviewed. Professionals demonstrated little consensus regarding the miscarriage rate, the potential consequences of amniocentesis testing and the uncertainty associated with the tests. Furthermore, methods employed to communicate risks varied between professionals. Pregnant women reported heightened stress and anxiety. Twelve out of 17 women described the decision as complex and difficult to make while five participants were satisfied with the information and support provided. Women would have liked more information about the risks involved, the results, the consequences of an amniocentesis and associated emotional difficulties. Women highlighted the need for personalized information, presented in multiple ways, while remaining simple and unbiased. Conclusions There is variation in the provision of information related to amniocentesis testing. The majority of pregnant women reported difficulties making a decision and identified dimensions of information and decision support where improvements were needed.

Many patients do not make a decision about the disposition of their surplus embryos until they are compelled to do so by statutory limits. In the current study, the characteristics of women who had conceived through in vitro fertilisation (IVF) and who still had embryos stored (E-S; n = 26) 5 years after IVF were compared to a cohort comparison group (C-C; n = 40). At time 1 (T1, 28 weeks pregnant) women completed questionnaires on personality traits (anxiety, locus of control and dependency) and participated in an interview on socio-demographic characteristics, family composition and stored embryos. At T2 (5 years later) women were re-interviewed and asked about beliefs about the embryos. Women in the E-S group were significantly younger, had been married or living with their partner for fewer years and had had more children than the C-C group. Further, women in the E-S group were more likely to have an external locus of control and a dependent personality than women in the C-C group. Almost all women in the E-S group (88.5%) thought of their embryos as siblings to existing children, and reported thinking about the embryos occasionally (61.5%) or frequently (34.6%). The personality differences identified may suggest that women who still have embryos after the end of fertility treatment may be in need of decision support.

Contains fulltext : 69384.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To identify and describe the extent to which theory or theoretical frameworks informed the development and evaluation of decision support technologies (DSTs). METHODS: The analysis was based on the decision technologies used in studies included in the Cochrane systematic review of patient decision aids for people facing health screening or treatment decisions. The assumption was made that DSTs evaluated by randomized controlled trials, and therefore included in the updated Cochrane review have been the most rigorously developed. RESULTS: Of the 50 DSTs evaluated only 17 (34%) were based on a theoretical framework. Amongst these, 11 decision-making theories were described but the extent to which theory informed the development, field-testing and evaluation of these interventions was highly variable between DSTs. The majority of the 17 DSTs that relied on a theory was not explicit about how theory had guided their design and evaluation. Many had superficial descriptions of the theory or theories involved. Furthermore, based on the analysis of those 17 DSTs, none had reported field-testing prior to evaluation. CONCLUSION: The use of decision-making theory in DST development is rare and poorly described. The lack of theoretical underpinning to the design and development of DSTs most likely reflects the early development stage of the DST field. PRACTICE IMPLICATIONS: The findings clearly indicate the need to give more attention to how the most important decision-making theories could be better used to guide the design of key decision support components and their modes of action.

Our aim was to clarify and categorize information and decision support needs of pregnant women deciding about amniocentesis.Prenatal screening for Down's syndrome (implemented in routine practice) generates a quantifiable risk of chromosome abnormality. To increase certainty, chromosomal material needs to be obtained through amniocentesis or other diagnostic test. Amniocentesis carries risks of pregnancy loss.Semi-structured interviews were conducted with health professionals and pregnant women who had considered amniocentesis. The data were qualitatively analysed using a two-step thematic content analysis.A sample of 17 health professionals and 17 pregnant women were interviewed. Professionals demonstrated little consensus regarding the miscarriage rate, the potential consequences of amniocentesis testing and the uncertainty associated with the tests. Furthermore, methods employed to communicate risks varied between professionals. Pregnant women reported heightened stress and anxiety. Twelve out of 17 women described the decision as complex and difficult to make while five participants were satisfied with the information and support provided. Women would have liked more information about the risks involved, the results, the consequences of an amniocentesis and associated emotional difficulties. Women highlighted the need for personalized information, presented in multiple ways, while remaining simple and unbiased.There is variation in the provision of information related to amniocentesis testing. The majority of pregnant women reported difficulties making a decision and identified dimensions of information and decision support where improvements were needed.