Positive experiences of patient-centred care are associated with intentions to comply with fertility treatment: findings from the validation of the Portuguese version of the PCQ-Infertility tool.

STUDY QUESTION: Are positive experiences of different aspects of patient-centred care (PCC) associated with higher intentions to comply with fertility treatment? SUMMARY ANSWER: Positive experiences regarding information received, respect from staff about values and preferences, continuity in treatment and competence of staff are directly associated with higher compliance intentions, while positive experiences regarding accessibility to and involvement in the treatment and communication with staff are indirectly associated, via associations with less concerns about treatment. WHAT IS KNOWN ALREADY: The quality of infertility services can influence patients' intentions to comply with treatment. Patients cite negative care experiences as one of the main reasons why they discontinue treatment prematurely. Delivering PCC in routine infertility care is associated with higher quality of life and lower distress during treatment. STUDY DESIGN, SIZE, DURATION: In this cross-sectional study of 265 women and 83 men, we investigated first, the psychometric properties of the Portuguese version of the Patient-Centredness Questionnaire (PCQ)-Infertility tool, which assesses infertility PCC, and secondly, the associations between PCC and intentions to comply with treatment. PARTICIPANTS/MATERIALS, SETTING,
METHODS: Men and women undergoing fertility diagnostic investigation or treatment at Portuguese fertility clinics were recruited online and in clinical setting. Participants filled out a socio-demographic and fertility data file and other questionnaires to assess PCC (PCQ-Infertility), intentions to comply with treatment (FertiQoL Persistence Scale), wellbeing (Anxiety and Depression subscales of the BSI and FertiQoL), concerns about treatment (CART Scale) and treatment tolerability (FertiQoL Tolerability Domain). MAIN RESULTS AND THE ROLE OF CHANCE: There were 265 women and 83 men who completed the questionnaires. The confirmatory factor analysis for the PCQ-Infertility indicated a good fit [X² = 479.097; P < 0.001; comparative fit index = 0.929; root mean square error of approximation = 0.058 (0.051-0.065)]. All PCQ-Infertility dimensions showed good internal consistency (α ≥ 0.70, excepting for organization: α = 0.57). Information provision, respect for patients' values, continuity of care and competence of the team were directly associated with higher intentions to comply with treatment (r from 0.13 to 0.23). Greater accessibility, patient involvement and good communication were negatively associated with concerns about treatment (r from -0.14 to -0.16) and less concerns were associated with higher intentions to comply with treatment (r from -0.14 to -0.15). LIMITATIONS, REASONS FOR CAUTION: Of the sample, 49% were recruited online. Patients recruited online had higher education and were more likely to be undergoing assisted reproduction treatment and this could have influenced the ratings of PCC reported. We did not account for treatment prognosis factors and/or doctor censuring and this may have resulted in underestimation of the strength of associations reported involving compliance intentions. The cross-sectional design of the study does not allow for cause and effect analysis between the study variables. WIDER IMPLICATIONS OF THE
FINDINGS: To promote treatment compliance, clinics should allow patients to establish stable relationships with a reference doctor who is competent and respectful of their interests and values and who provides them with the information they need. Clinics can also alleviate their patients' concerns regarding medical procedures by ensuring that these professionals are easily accessible, have good communication skills, and involve patients in the treatment process and associated decision-making. The Portuguese version of the PCQ-Infertility tool is valid and reliable.