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Monday room08-1645.aarts


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This is my presentation on the use of Internet applications within reproductive medicine held on the Medicine 2.0 conference in Maastricht.

This is my presentation on the use of Internet applications within reproductive medicine held on the Medicine 2.0 conference in Maastricht.

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  • 1. An overview of challenges and possibilities of the Internet in fertility care Annemijn Aarts,Pieter van den Haak, WillianneNelen, Wouter Tuil, Marjan Faber, Jan KremerRadboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Medicine 2.0 Maastricht 2010
  • 2. 80.000.000 infertilepeopleworldwide 1 out of every 4 couples1Anyform of reducedfertilitywithprolonged time of unwanted non-conception2 Cause Male Female Both Unexplained 1Nachtingall, FertilSteril2006 2Gnoth et al., Hum Reprod 2005
  • 3. Itdoesn’tcome easy… Reproductivetechniques, such as IVF 1Verhaak et al., Hum Reprod Update 2007 2Schmidt, Lancet 2006
  • 4. Fertility and reproductionembedded in our lives…
  • 5. Ideal Internet population1,2 Emotional impactStigmatisingcondition Young HighlyeducatedNeed forinformation Want to beinvolved Lookingfor support 1Weismann et al., FertilSteril 2000 2Haagen et al., Hum Reprod 2003
  • 6. However, notintegratedintousual care.. yet!eHealth Clinicalpractice
  • 7. Studyobjectives1. Overview of current Internet applications in reproductivemedicine2. Methodologicalconsiderations and recommendationsforfuture research
  • 8. METHODS
  • 9. 5 databases1217 studies Patient-focused eHealth18 studies
  • 10. Data extraction and synthesis1. Type of usage and behaviour of web-basedapplications2. Effects of web-basedapplications
  • 11. RESULTS
  • 12. Infertilityspecific Internet applicationsOnline support groups- Qualitative research- Social and emotional supportDecisionaid- Oncologicalpatientsfacinginfertilitydue to chemotherapy- RCT and before-after design: small sample sizes- Knowledge, decisional conflictPsychoeducationaltreatment- Aim: reducing stress, anxiety, depression- RCT: No orsmalleffectsfound
  • 13. Infertilityspecific internet applications (cntd)Personal Health Record- Generic and personalinformation- Communication (private forum and chatroom)- Online behaviour- RCT: no effect onpatientempowermentExpert Forum- Multidisciplinary team- Content of requestsstudied- Patientssatisfied
  • 14. Summary of findings • Patients are enthusiastic • Patientsfindithelpful and supporting • Effectivenesscouldnotbeestablished, which is neededforsuccesfulintegrationintoclinical careHowever…. • Someinterestingconclusionscanbedrawn
  • 16. (1) Fills the gap betweenpatients’ needsand the supportclinicscan offerPHR (Tuil et al., 2009)Stages of IVF treatment
  • 17. (1) Filling the gap betweenpatients’ needsand the supportclinicscan offer DA (Meneseset al.; Huyghe et al.2010) Oncologistscannotfullfil the informationneed of oncologicalpatientsonfertilitypr eservation
  • 18. (1) Filling the gap betweenpatients’ needsand the supportclinicscan offer Forum (Malik, 2008) Support forinfertile men
  • 19. (2) Connected to primary care processChat topics van Selm, et al. 20081. IVF treatment2. ChildlessnessRequestson Expert forum Himmel, et al. 20081. Information and explanation2. Guidance in decisionsduringtreatmentOnline support groupse.g. Malik &Coulson, 2008, 20101. Lookingforpatientswhowereundergoing the same at that moment
  • 20. (3) Improvingquality of fertility care bymakingit more patient-centredTailoring care to individualneeds and preferences (Berwick, 2002)Core elements of patient-centredfertility careDancet et al, 2010 Online peer supportVan Empel et al, 2010 Access to theirmedicalhealth recordPatientinvolvement Accurate and complete informationCollective levelPatientscanunite online  Votewiththeirfeet  Qualityimprovement
  • 22. (1) Itrequires time to mature• Follow up period• Not mentionedor maximum of 6 months Hansen, 2007 9 months to mature
  • 23. (2) Prevent high attritionratesSextonet al. 2010 67% %Haemmerliet al.2009 50%Especially in fertility care -Drop out1 -Pregnant along the way time User-centredintervention: Patients as anintegral part of development team E.g.Personal Health Record (Tuil et al) 1Brandes et al., Hum Reprod 2009
  • 24. (3) Study design: Randomizedcontrolled trial not the gold standard• RCT is not patient-centred2• eHealth is patient-orientedinstead of disease- or doctor-oriented1 Patients free to choosewhat to use• Dynamic and changingcharacter of the Internet3 1Swan; 2Bensing, 2000; 3Potts, 2006
  • 25. (4) The value of observational and qualitative studies in eHealth research• Choosingappropriate ‘ingredients’ requiresknowledge of workingmechanism Shedlightonwhyitworks (ordoesn’t)3• More able to detectpossible‘sideeffects’ and chooseappropriateoutcome measures1-3 1Smulder, 2010; 2Kohler 2009; 3Shrier, 2007
  • 26. eHealth in fertility care is promisingfrom apatient’sperspective, although more research is needed Twitter: aartsja.aarts@obgyn.umcn.
  • 27. Questions are guaranteed in life; answersaren’t (Francis Bacon)Thankyouforyourattention! Twitter: aartsja.aarts@obgyn.umcn.