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• W2217311479 abstract "The disposition of surplus embryos is emotionally challenging for couples and presents a perplexing burden on resources and storage for clinical practices. Deniz et al. (1Deniz S.G. Highes E.G. Neal M.S. Faghih M. Amin S. Karnis M.F. The role of patient education in facilitating future decisions regarding the disposition of surplus embryos.Fertil Steril. 2016; 105: 684-689Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar) examined the effectiveness of professional education provided to Canadian couples about options for surplus embryo disposition. All couples in the study had received counseling from a health care professional about the potential for surplus embryos and options for disposal. The majority of couples reported decision making was challenging and couples who had experienced infertility for greater than three years were more likely to feel conflicted about their disposition decision than couples with a shorter duration of infertility. Professional counsel about the use of, and consequences associated with assisted reproductive technologies is imperative for couples or individuals seeking these services. The challenge lies in patients' abilities to think about the future and envision scenarios in which they will likely feel differently than they are feeling in the present. Provoost et al surveyed female patients about their plans for continued storage of cryopreserved embryos (2Provoost V. Pennings G. De Sutter P. Gerris J. Van de Velde A. Dhont M. To Continue or discontinue storage of cryopreserved embryos? Patients’ decisions in view of their child wish.Hum Reprod. 2011; 26: 861-872Crossref PubMed Scopus (29) Google Scholar). At the time of initial storage the majority of patients intended to use their embryos in the future. When the survey was conducted two years later, 70% of respondents considered their families to be complete yet 40% elected to continue to store their embryos, with no concrete plans to use them in the future. In contrast, Lyerly et al. (3Lyerly A.D. Steinhauser K. Voils C. Namey E. Alexander C. Bankowski B. et al.Fertility patients’ views about frozen embryo disposition: results of a multi-institutional U.S. survey.Fertil Steril. 2010; 93: 499-509Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar) surveyed American fertility patients about frozen embryo disposition and found 54% intended to use their embryos for a future pregnancy attempt and 21% were considering donating their surplus embryos to research. Of those respondents who were certain they wanted no future children the most acceptable disposition options were compassionate transfer (70%) and a disposal ceremony (60%). The authors suggest the need for restructured and improved informed consent documents to facilitate decision- making. Each of the studies points to need for improved patient education at the time of initial storage. The principles of shared decision making rely on three key components: ensuring the creation of a good relationship in the clinical encounter; allowing patients to express their preferences and views; and presenting information that allows patients to deliberate, leading to reduced conflict about decisions. A proposed model of shared decision making encompasses choice, option and decision talk. The model supports the process of patient deliberation understanding that decisions are influenced by exploring and respecting “what matters most” to patients as individuals, and this exploration is imperative for them to develop informed preferences (4Elwyn G. Frosch D. Thomson R. Joseph-Williams N. Lloyd A. Kinnersley P. et al.Shared decision making: a model for clinical practice.J Intern Med. 2012; 27: 1361-1367Google Scholar). One method for improving patient decision -making about surplus embryos may be to encourage peer discussion. Providing opportunities for couples or individuals completing ART to hear from others who have already undergone the process may enhance informed decision-making by allowing them to learn what matters in the future. Learning about the emotional challenges inherent to the disposition of surplus embryos from couples who have already been in that situation may allow novice couples to foresee themselves in that same future. The excitement and thrill of potentially fulfilling the goal of pregnancy and parenting by infertile couples through the use of ART likely clouds judgment about disposal of surplus embryos. For those couples for whom ART is successful and at least one embryo becomes a child with a name, it is difficult to consider disposing of embryos who are potential siblings. A brave woman from the United States posted a video to YouTube (https://www.youtube.com/watch?v=8YcytNp9IFk) about her struggle with the disposition of 20 surplus embryos. She noted the difficulty in finding other women in similar situations to discuss decision -making and the legal challenges in her state for embryo donation either to other couples or to research. While the majority of comments on her video blog were supportive of her struggle and showed appreciation for her sharing her challenge, several comments were vilifying and accusatory of homicide. This highlights the lack of support couples may receive for the very personal decisions related to embryo disposition. The fierce controversy and public debate over the fate of unused embryos likely forces couples to remain silent about their personal decisions or elect to store them indefinitely in lieu of making a decision. The Deniz et al. (1Deniz S.G. Highes E.G. Neal M.S. Faghih M. Amin S. Karnis M.F. The role of patient education in facilitating future decisions regarding the disposition of surplus embryos.Fertil Steril. 2016; 105: 684-689Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar) article emphasizes the great need to improve shared decision-making and perhaps mandatory, private, peer counseling may offer a new aspect of choice. Are health care providers adequately educating couples for embryo disposition decisions?Fertility and SterilityVol. 105Issue 3PreviewTo determine the effectiveness of education provided by health care professionals during and after IVF treatment in preparing couples for surplus embryo disposition decisions. Full-Text PDF" @default.
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• W2217311479 title "Peer counseling to improve shared decision making in surplus embryo disposition" @default.
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