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.

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Monday room08-1645.aarts

  1. 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. 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. 3. Itdoesn’tcome easy… Reproductivetechniques, such as IVF 1Verhaak et al., Hum Reprod Update 2007 2Schmidt, Lancet 2006
  4. 4. Fertility and reproductionembedded in our lives…
  5. 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. 6. However, notintegratedintousual care.. yet!eHealth Clinicalpractice
  7. 7. Studyobjectives1. Overview of current Internet applications in reproductivemedicine2. Methodologicalconsiderations and recommendationsforfuture research
  8. 8. METHODS
  9. 9. 5 databases1217 studies Patient-focused eHealth18 studies
  10. 10. Data extraction and synthesis1. Type of usage and behaviour of web-basedapplications2. Effects of web-basedapplications
  11. 11. RESULTS
  12. 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. 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. 14. Summary of findings • Patients are enthusiastic • Patientsfindithelpful and supporting • Effectivenesscouldnotbeestablished, which is neededforsuccesfulintegrationintoclinical careHowever…. • Someinterestingconclusionscanbedrawn
  16. 16. (1) Fills the gap betweenpatients’ needsand the supportclinicscan offerPHR (Tuil et al., 2009)Stages of IVF treatment
  17. 17. (1) Filling the gap betweenpatients’ needsand the supportclinicscan offer DA (Meneseset al.; Huyghe et al.2010) Oncologistscannotfullfil the informationneed of oncologicalpatientsonfertilitypr eservation
  18. 18. (1) Filling the gap betweenpatients’ needsand the supportclinicscan offer Forum (Malik, 2008) Support forinfertile men
  19. 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. 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. 22. (1) Itrequires time to mature• Follow up period• Not mentionedor maximum of 6 months Hansen, 2007 9 months to mature
  23. 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. 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. 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. 26. eHealth in fertility care is promisingfrom apatient’sperspective, although more research is needed Twitter: aartsja.aarts@obgyn.umcn.
  27. 27. Questions are guaranteed in life; answersaren’t (Francis Bacon)Thankyouforyourattention! Twitter: aartsja.aarts@obgyn.umcn.