Patient autonomy in ART: Examining the preferred role in treatment decision making among Chinese infertile women

Abstract

Treatment decision-making as central to patient participation in healthcare, which leads to patient autonomy and empowerment. Studies on professionals at assisted reproduction clinics revealed that infertilite patients as unassertive, compliant and largely reliant on physicians in different aspects of treatment decisions, especially whether deciding to continue or terminate treatment altogether. However, without recruiting patients as informers, little is known about their actual experience and preference. The study attempted to understand the treatment decision making preferences in Chinese women undergoing fertility treatments. A cross-sectional survey was conducted with infertile women undergoing IVF. Information was collected on infertility diagnosis, treatment history, their preferred decision making role, and demographic characteristics. Women undergoing IVF treatment were approached in a fertility clinic on the day of pregnancy test. 205 completed questionnaires were eventually returned. On average, participants were 37.0 years±3.5, married for 7.4 years±3.7, and suffered subfertility for 4.1 years. Most of them preferred shared by leaning passive role (41.9%) or total passive role (40.4%). 89.4% of them considered doctors should best decide diagnosis and evaluate treatment options, only 10.1% preferred to share responsibility and no one resume an autonomous role. Similarly, most women prefer minimal role and rely heavily on physicians to decide whether to continue or terminate further treatments (84.3%), only a small proportion prefer to share responsibility (7.1%), or seize autonomy (8.6%). Chinese infertile women appeared to be more compliant in making treatment decisions as compared to their Western counterparts. Results revealed majority of Chinese infertile women prefer to rely on healthcare physicians and adopt minimal role in treatment decision making, which aligned with subjective impression held by healthcare professionals, highlighting a need to empower and facilitate Chinese women in fertility treatment decisions in order to improved clinical outcomes. This study adds to our understanding of Chinese women’s role preference and level of involvement in infertility treatment decision making by providing quantitative evidence from patients subject experience.